Provider Demographics
NPI:1902916596
Name:TAYLOR, SANDRA LEIGH (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEIGH
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:3901 WINFORD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2069
Mailing Address - Country:US
Mailing Address - Phone:214-533-9792
Mailing Address - Fax:
Practice Address - Street 1:1201 E 15TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6238
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7044632Medicare UPIN
TX87508TMedicare UPIN