Provider Demographics
NPI:1861926081
Name:TAYLOR, BROOKE ASHLEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ASHLEN
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 1:87 DRESSER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1337
Mailing Address - Country:US
Mailing Address - Phone:774-218-0354
Mailing Address - Fax:
Practice Address - Street 1:87 DRESSER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1337
Practice Address - Country:US
Practice Address - Phone:774-218-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14227669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist