Provider Demographics
NPI:1134803000
Name:ROHM, TAYLOR JORDYN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JORDYN
Last Name:ROHM
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 1:1524 GARDENSIDE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0361
Mailing Address - Country:US
Mailing Address - Phone:630-523-4986
Mailing Address - Fax:
Practice Address - Street 1:211 PRATHER PARK DR UNIT B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7983
Practice Address - Country:US
Practice Address - Phone:843-640-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty