Provider Demographics
NPI:1053574194
Name:TAYLOR, JENNIFER MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:1390 HIGHWAY 61-67 SOUTH
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0350
Mailing Address - Country:US
Mailing Address - Phone:636-933-1606
Mailing Address - Fax:636-933-1871
Practice Address - Street 1:1390 HIGHWAY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-0350
Practice Address - Country:US
Practice Address - Phone:636-933-1606
Practice Address - Fax:636-933-1871
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103567231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103567OtherSTATE OF MISSOURI DIVISION OF PROFESSIONAL REGISTRATION