Provider Demographics
NPI:1154991198
Name:TAYLOR, DUSTI (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DUSTI
Middle Name:
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 1:600 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4324
Mailing Address - Country:US
Mailing Address - Phone:377-909-2658
Mailing Address - Fax:
Practice Address - Street 1:1021 ALCIDE BONIN RD.
Practice Address - Street 2:
Practice Address - City:CECILIA
Practice Address - State:LA
Practice Address - Zip Code:70521
Practice Address - Country:US
Practice Address - Phone:337-909-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-6001274Medicaid