Provider Demographics
NPI:1295023091
Name:MCINTURF, TARA MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MARIE
Last Name:MCINTURF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:CANADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8077
Mailing Address - Country:US
Mailing Address - Phone:859-684-0475
Mailing Address - Fax:
Practice Address - Street 1:125 SAGE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8077
Practice Address - Country:US
Practice Address - Phone:859-684-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist