Provider Demographics
NPI:1972716165
Name:BOYD, TARA SHAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:SHAE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10599 N TATUM BLVD STE F153
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1053
Mailing Address - Country:US
Mailing Address - Phone:602-606-2237
Mailing Address - Fax:844-475-2307
Practice Address - Street 1:10599 N TATUM BLVD STE F153
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1053
Practice Address - Country:US
Practice Address - Phone:602-606-2237
Practice Address - Fax:844-475-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN352183400Medicaid
MN384M2BEOtherBCBS GROUP
MN384M3BEOtherBCBS INDIVIDUAL