Provider Demographics
NPI:1972624401
Name:STREIT, TARRA KAYE (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:KAYE
Last Name:STREIT
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16054 SYMPHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-9299
Mailing Address - Country:US
Mailing Address - Phone:317-770-8333
Mailing Address - Fax:
Practice Address - Street 1:8060 KNUE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1976
Practice Address - Country:US
Practice Address - Phone:317-842-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003810A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist