Provider Demographics
NPI:1104492164
Name:BABASHKA, TAYLOR (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BABASHKA
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 1:22024 BEERS RD
Mailing Address - Street 2:
Mailing Address - City:COPEMISH
Mailing Address - State:MI
Mailing Address - Zip Code:49625-9744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1345 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9318
Practice Address - Country:US
Practice Address - Phone:231-398-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.016405235Z00000X
MI7101008365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist