Basic Information
| Provider Information | |||||||||
| NPI: | 1992014831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | AU.D., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 S SONCY RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063555625 | ||||||||
| FaxNumber: | 8063522245 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 S SONCY RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063555625 | ||||||||
| FaxNumber: | 8063522245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 80243 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 80243 | 01 | TX | STATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY | OTHER |