Provider Demographics
NPI:1053080424
Name:TAYLOR, KRISTEN LOVE DESTINY (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LOVE DESTINY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31053 CONQUEST FARM LN
Mailing Address - Street 2:
Mailing Address - City:HALLWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:23359-2662
Mailing Address - Country:US
Mailing Address - Phone:757-894-7043
Mailing Address - Fax:
Practice Address - Street 1:23296 COURTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:ACCOMAC
Practice Address - State:VA
Practice Address - Zip Code:23301
Practice Address - Country:US
Practice Address - Phone:757-787-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist