Provider Demographics
NPI:1396042396
Name:TULLIS, TARA ROONEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ROONEY
Last Name:TULLIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-4200
Mailing Address - Country:US
Mailing Address - Phone:415-476-7730
Mailing Address - Fax:415-502-3556
Practice Address - Street 1:675 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-4200
Practice Address - Country:US
Practice Address - Phone:415-476-7730
Practice Address - Fax:415-502-3556
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-8176-SL235Z00000X
CA17980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist