Provider Demographics
NPI:1598278095
Name:MCGRAW, TARA KAY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:KAY
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E WALL ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61753-1462
Mailing Address - Country:US
Mailing Address - Phone:309-365-4141
Mailing Address - Fax:
Practice Address - Street 1:100 E WALL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:IL
Practice Address - Zip Code:61753-1462
Practice Address - Country:US
Practice Address - Phone:309-365-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2040742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty