Provider Demographics
NPI:1861049223
Name:BARUM, TAYLOR LEIGH
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEIGH
Last Name:BARUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 CAMERONS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3331
Mailing Address - Country:US
Mailing Address - Phone:724-678-2063
Mailing Address - Fax:
Practice Address - Street 1:6026 CAMERONS FERRY DR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-3331
Practice Address - Country:US
Practice Address - Phone:724-678-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist