Provider Demographics
NPI:1265908503
Name:TAYLOR, CARRIE W (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:CHRISTINE
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6434 JEFFREY CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6531
Mailing Address - Country:US
Mailing Address - Phone:707-490-4811
Mailing Address - Fax:
Practice Address - Street 1:6211 MULLEN RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7146
Practice Address - Country:US
Practice Address - Phone:360-412-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18878235Z00000X
WALL60868497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12133177OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
WALL60868497OtherWASHINGTON STATE SPEECH LANGUAGE PATHOLOGY LICENSE