Provider Demographics
NPI:1174863195
Name:CARROLL, TARA P (MCD, CCC/A)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:P
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MCD, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 CALHOUN ST
Mailing Address - Street 2:ROOM O-327
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2606
Mailing Address - Country:US
Mailing Address - Phone:803-898-0708
Mailing Address - Fax:
Practice Address - Street 1:1751 CALHOUN ST
Practice Address - Street 2:ROOM O-327
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2606
Practice Address - Country:US
Practice Address - Phone:803-898-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2275231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist