Provider Demographics
NPI:1710944368
Name:CALL, TARA LEAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEAH
Last Name:CALL
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 1:1218 N CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2603
Mailing Address - Country:US
Mailing Address - Phone:479-957-4595
Mailing Address - Fax:479-527-0114
Practice Address - Street 1:1218 N CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-2603
Practice Address - Country:US
Practice Address - Phone:479-957-4595
Practice Address - Fax:479-527-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154633721Medicaid