Provider Demographics
NPI:1013199967
Name:SOTH, TARA RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:SOTH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:GOUSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5900 METRO DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3207
Mailing Address - Country:US
Mailing Address - Phone:410-318-6780
Mailing Address - Fax:410-318-6759
Practice Address - Street 1:5900 METRO DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3207
Practice Address - Country:US
Practice Address - Phone:410-318-6780
Practice Address - Fax:410-318-6759
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD883994-02OtherCARE FIRST BCBS
DCJ175-0024OtherCAREFIRST BCBS
MD883994-01OtherCAREFIRST BCBS