MEDICARE: TAYLOR RICHARDSON SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6261377	ID

General Provider Information

NPI Number	:	1790577658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR RICHARDSON SLP

Provider Business Mailing Address
First Line	:	581 N WHITEWATER PARK BLVD APT D202
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 W STATE ST STE C
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6428
Country	:	US
Telephone Number	:	208-996-0828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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Directions to “ TAYLOR RICHARDSON SLP” Practice Location

Language	Start Address	Practice Location

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