Provider Demographics
NPI:1710211131
Name:HUGGARD, TARA LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:HUGGARD
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 1:125 REESER ST
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9529
Mailing Address - Country:US
Mailing Address - Phone:610-413-9233
Mailing Address - Fax:
Practice Address - Street 1:1 HEIDELBERG DR
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1642
Practice Address - Country:US
Practice Address - Phone:610-927-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL008930OtherASHA