Provider Demographics
NPI:1487618864
Name:TAYLOR, DEBORAH L (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:TAYLOR
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 1:45 INDIAN CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1909
Mailing Address - Country:US
Mailing Address - Phone:863-513-8223
Mailing Address - Fax:
Practice Address - Street 1:45 INDIAN CREEK TRL
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-1909
Practice Address - Country:US
Practice Address - Phone:863-513-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3228235Z00000X
FLSA4742235Z00000X
GASLP008528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8874131-00Medicaid