Provider Demographics
NPI:1194555375
Name:MCINTYRE, TAYLOR GE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:GE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 EPPING LN
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1133
Mailing Address - Country:US
Mailing Address - Phone:347-374-0953
Mailing Address - Fax:
Practice Address - Street 1:1254 EPPING LN
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-1133
Practice Address - Country:US
Practice Address - Phone:347-374-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011268235Z00000X
GASLP012606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist