Provider Demographics
NPI:1912028051
Name:YORK, TARA (SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:714 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5918
Mailing Address - Country:US
Mailing Address - Phone:620-275-0291
Mailing Address - Fax:
Practice Address - Street 1:714 BALLINGER ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5918
Practice Address - Country:US
Practice Address - Phone:620-275-0291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist