Provider Demographics
NPI:1043904576
Name:WILLIAMS, TAYLOR JORDAN (MS SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JORDAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 DAYDREAM AVE APT 5201
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5470
Mailing Address - Country:US
Mailing Address - Phone:484-627-3365
Mailing Address - Fax:
Practice Address - Street 1:463155 STATE ROAD 200 STE 12
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5506
Practice Address - Country:US
Practice Address - Phone:904-849-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist