Provider Demographics
NPI:1124718143
Name:TAYLOR MADE SPEECH THERAPY LLC
Entity type:Organization
Organization Name:TAYLOR MADE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:225-240-8145
Mailing Address - Street 1:6313 LEMON RD
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTER
Mailing Address - State:LA
Mailing Address - Zip Code:70777-9694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6313 LEMON RD
Practice Address - Street 2:
Practice Address - City:SLAUGHTER
Practice Address - State:LA
Practice Address - Zip Code:70777-9694
Practice Address - Country:US
Practice Address - Phone:225-240-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty