Provider Demographics
NPI:1245893288
Name:ENGLAND, TARA (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ENGLAND
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 1:1963 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8344
Mailing Address - Country:US
Mailing Address - Phone:606-594-4691
Mailing Address - Fax:
Practice Address - Street 1:96 HIGHWAY 3444
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402-8245
Practice Address - Country:US
Practice Address - Phone:606-364-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist