Provider Demographics
NPI:1871748830
Name:TAYLOR, STACY LYNN (MA CCC/SLP-L)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA CCC/SLP-L
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:MECKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP-L
Mailing Address - Street 1:6150 GLEBE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9038
Mailing Address - Country:US
Mailing Address - Phone:173-902-6717
Mailing Address - Fax:
Practice Address - Street 1:6150 GLEBE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9038
Practice Address - Country:US
Practice Address - Phone:317-902-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002668L235Z00000X
IN22005051235Z00000X
IN22005105A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001944653Medicaid