Provider Demographics
NPI:1083920730
Name:COURTNEY, TARA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:COURTNEY
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 1:16 TUTWILER CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7637
Mailing Address - Country:US
Mailing Address - Phone:601-297-4489
Mailing Address - Fax:
Practice Address - Street 1:16 TUTWILER CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7637
Practice Address - Country:US
Practice Address - Phone:601-297-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist