Provider Demographics
NPI:1649390477
Name:GRIGGS, TAMARA CARRELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:CARRELL
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 GARDENIA LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4505
Mailing Address - Country:US
Mailing Address - Phone:870-577-5234
Mailing Address - Fax:
Practice Address - Street 1:383 GARDENIA LN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4505
Practice Address - Country:US
Practice Address - Phone:870-577-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126379721Medicaid