Provider Demographics
NPI:1639414535
Name:BARON, TARA R (MA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:R
Last Name:BARON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:R
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:574 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1616
Mailing Address - Country:US
Mailing Address - Phone:847-209-7703
Mailing Address - Fax:
Practice Address - Street 1:2901 FINLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1394
Practice Address - Country:US
Practice Address - Phone:630-792-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3694418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208566913OtherKIND WORD SPEECH PATHOLOGY