MEDICARE: TAYLOR KILEN M.A., CCC-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	LL60991440	WA
2	235Z00000X	Speech-Language Pathologist	6117018690	CT
3	235Z00000X	Speech-Language Pathologist	006461	CT
4	235Z00000X	Speech-Language Pathologist	551192H	WA

General Provider Information

NPI Number	:	1972376713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR KILEN M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	100 CHURCH HILL RD
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1303
Country	:	US
Telephone Number	:	360-718-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CHURCH HILL RD
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1303
Country	:	US
Telephone Number	:	360-718-0029
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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Directions to “ TAYLOR KILEN M.A., CCC-SLP” Practice Location

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