Provider Demographics
NPI:1922829654
Name:PLACEK, TAYLOR (M ED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PLACEK
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 SUMMERTREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7794
Mailing Address - Country:US
Mailing Address - Phone:919-606-3270
Mailing Address - Fax:
Practice Address - Street 1:3315 SPRINGBANK LN STE 206N
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3198
Practice Address - Country:US
Practice Address - Phone:704-847-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty