Provider Demographics
NPI:1942755624
Name:VOLKMANN, TARA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:VOLKMANN
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:UNIT 3120 BOX 52
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AA
Mailing Address - Zip Code:34055-0052
Mailing Address - Country:US
Mailing Address - Phone:619-324-9733
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3120 BOX 52
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AA
Practice Address - Zip Code:34055-0052
Practice Address - Country:US
Practice Address - Phone:619-324-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19395235Z00000X
GASLP008287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist