Provider Demographics
NPI:1366126195
Name:PAUL, TAYLOR BROOKE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BROOKE
Last Name:PAUL
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 1:101 RON MAR DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4566
Mailing Address - Country:US
Mailing Address - Phone:318-229-6435
Mailing Address - Fax:
Practice Address - Street 1:101 RON MAR DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4566
Practice Address - Country:US
Practice Address - Phone:318-229-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist