Provider Demographics
NPI:1245561612
Name:ROOF, TARA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ROOF
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 1:1560 KINNARD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3264
Mailing Address - Country:US
Mailing Address - Phone:615-587-2683
Mailing Address - Fax:615-595-4255
Practice Address - Street 1:1560 KINNARD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3264
Practice Address - Country:US
Practice Address - Phone:615-587-2683
Practice Address - Fax:615-595-4255
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist