Provider Demographics
NPI:1982580767
Name:MOULTRIE, TAYLOR JADE (SLP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JADE
Last Name:MOULTRIE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JADE
Other - Last Name:TOUVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:513-861-0300
Mailing Address - Fax:513-861-0213
Practice Address - Street 1:3700 PARK 42 DR STE 105A
Practice Address - Street 2:
Practice Address - City:SHARONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45241-2081
Practice Address - Country:US
Practice Address - Phone:513-861-0300
Practice Address - Fax:513-861-0213
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14356076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist