Provider Demographics
NPI:1063260800
Name:TAYLOR, BROOKE MACKENZIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MACKENZIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 MAIN ST UNIT 1402
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7888
Mailing Address - Country:US
Mailing Address - Phone:401-487-4197
Mailing Address - Fax:
Practice Address - Street 1:30 MARTIN ST STE 4B
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5321
Practice Address - Country:US
Practice Address - Phone:401-228-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist