Provider Demographics
NPI:1386260974
Name:LOVELL, TAYLOR CHRISTINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTINE
Last Name:LOVELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:OK
Mailing Address - Zip Code:74650-2247
Mailing Address - Country:US
Mailing Address - Phone:405-694-1815
Mailing Address - Fax:
Practice Address - Street 1:1601 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4409
Practice Address - Country:US
Practice Address - Phone:580-762-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist