Provider Demographics
NPI:1033565759
Name:HEFLIN, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HEFLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-240 KEALOHI ST APT 142
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2626
Mailing Address - Country:US
Mailing Address - Phone:352-274-0600
Mailing Address - Fax:
Practice Address - Street 1:94-240 KEALOHI ST APT 142
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2626
Practice Address - Country:US
Practice Address - Phone:352-274-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist