Provider Demographics
NPI:1528198207
Name:BASS, TARA
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:BASS
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 1:401 NORTH ALLISON
Mailing Address - Street 2:
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062
Mailing Address - Country:US
Mailing Address - Phone:816-580-7277
Mailing Address - Fax:816-296-7723
Practice Address - Street 1:401 NORTH ALLISON
Practice Address - Street 2:
Practice Address - City:LAWSON
Practice Address - State:MO
Practice Address - Zip Code:64062
Practice Address - Country:US
Practice Address - Phone:816-580-7277
Practice Address - Fax:816-296-7723
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist