Provider Demographics
NPI:1154074078
Name:BLEDSOE, TAYLOR (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:ALDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:TX
Mailing Address - Zip Code:77629-0310
Mailing Address - Country:US
Mailing Address - Phone:409-659-2076
Mailing Address - Fax:
Practice Address - Street 1:115 HIGHWAY 326 S
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659-7871
Practice Address - Country:US
Practice Address - Phone:409-554-0689
Practice Address - Fax:409-554-0483
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist