Provider Demographics
NPI:1811386386
Name:BANKS, TAMARA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BANKS
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 1:19714 HURST WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2164
Mailing Address - Country:US
Mailing Address - Phone:832-607-1608
Mailing Address - Fax:
Practice Address - Street 1:19714 HURST WOOD DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2164
Practice Address - Country:US
Practice Address - Phone:832-607-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist