Provider Demographics
NPI:1730386392
Name:TAYLOR, DAWN M (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:TAYLOR
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 1:1052 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7055
Mailing Address - Country:US
Mailing Address - Phone:208-524-0941
Mailing Address - Fax:
Practice Address - Street 1:1052 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7055
Practice Address - Country:US
Practice Address - Phone:208-524-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist