Provider Demographics
NPI:1447602354
Name:TUCKER, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 S SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4726
Mailing Address - Country:US
Mailing Address - Phone:480-883-3854
Mailing Address - Fax:
Practice Address - Street 1:3160 N ARIZONA AVE
Practice Address - Street 2:STE. 109
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7122
Practice Address - Country:US
Practice Address - Phone:480-883-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA100192355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant