Basic Information
| Provider Information | |||||||||
| NPI: | 1790360576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 519 N LAKEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | RIDGELEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267539834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048137628 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 135 SOUTHERN DR | ||||||||
| Address2: | |||||||||
| City: | KEYSER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267262010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047883415 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 1960 | WV | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 09108 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.