Provider Demographics
NPI:1528388006
Name:GAY, TARA A (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:GAY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:108 LEIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8058
Mailing Address - Country:US
Mailing Address - Phone:843-277-4072
Mailing Address - Fax:
Practice Address - Street 1:108 LEIGHTON CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8058
Practice Address - Country:US
Practice Address - Phone:843-277-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA5811Medicaid