Provider Demographics
NPI:1205514395
Name:FAXON, TAYLOR ANNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANNE
Last Name:FAXON
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 1:683 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-3071
Mailing Address - Country:US
Mailing Address - Phone:513-535-0893
Mailing Address - Fax:
Practice Address - Street 1:4529 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1005
Practice Address - Country:US
Practice Address - Phone:513-943-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist