Provider Demographics
NPI:1104587799
Name:WEAVER-ROSAMILIA, TAYLOR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WEAVER-ROSAMILIA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 N 500 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-9709
Mailing Address - Country:US
Mailing Address - Phone:567-674-9450
Mailing Address - Fax:
Practice Address - Street 1:3700 ROME DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4489
Practice Address - Country:US
Practice Address - Phone:765-448-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist