Provider Demographics
NPI:1881198752
Name:HEDMAN, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:HEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4297 AUSTIN BLUFFS PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2953
Mailing Address - Country:US
Mailing Address - Phone:719-235-5325
Mailing Address - Fax:
Practice Address - Street 1:4297 AUSTIN BLUFFS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2953
Practice Address - Country:US
Practice Address - Phone:719-235-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health