Provider Demographics
NPI:1447096276
Name:BALLARD, TAYLOR NICOLE (MS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 LEGACY CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1253
Mailing Address - Country:US
Mailing Address - Phone:331-249-6626
Mailing Address - Fax:
Practice Address - Street 1:1516 LEGACY CIR STE 100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1253
Practice Address - Country:US
Practice Address - Phone:331-249-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist