Provider Demographics
NPI:1114253200
Name:TATE, KARLA BARRENTINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:BARRENTINE
Last Name:TATE
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 1:3067 ATTALA ROAD 2247
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-5033
Mailing Address - Country:US
Mailing Address - Phone:601-953-2920
Mailing Address - Fax:
Practice Address - Street 1:3067 ATTALA ROAD 2247
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-5033
Practice Address - Country:US
Practice Address - Phone:601-953-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS151078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist