Provider Demographics
NPI:1154651297
Name:GALLAGHER, TARA DAWN (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DAWN
Last Name:GALLAGHER
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 1:8206 SW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3629
Mailing Address - Country:US
Mailing Address - Phone:352-337-1468
Mailing Address - Fax:
Practice Address - Street 1:8206 SW 36TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3629
Practice Address - Country:US
Practice Address - Phone:352-337-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist