Provider Demographics
NPI:1447920376
Name:TAYLOR, MARTHA LYNN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1314 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7637
Mailing Address - Country:US
Mailing Address - Phone:281-840-2812
Mailing Address - Fax:
Practice Address - Street 1:1820 PEARL ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6119
Practice Address - Country:US
Practice Address - Phone:972-968-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103210Medicaid