Provider Demographics
NPI:1326327321
Name:BOYLE, TARA J (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 TAPLOW TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3662
Mailing Address - Country:US
Mailing Address - Phone:804-310-8607
Mailing Address - Fax:
Practice Address - Street 1:3606 TAPLOW TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3662
Practice Address - Country:US
Practice Address - Phone:804-310-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist