Provider Demographics
NPI:1780824680
Name:TROTT, TARA NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NICOLE
Last Name:TROTT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:TROTT
Other - Last Name:LAGING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:109 CARLINA LOOP
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-0025
Mailing Address - Country:US
Mailing Address - Phone:512-884-0175
Mailing Address - Fax:
Practice Address - Street 1:109 CARLINA LOOP
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-0025
Practice Address - Country:US
Practice Address - Phone:346-531-9448
Practice Address - Fax:512-988-5459
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110687235Z00000X
AZ14056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09894354OtherSTATE OF TEXAS DRIVERS LICENSE
13562404OtherCAQH
14101180OtherASHA CERTIFICATION NUMBER
TX1Z0625Medicaid
TX110687OtherSTATE OF TEXAS SLP LICENSE