Provider Demographics
NPI:1477126720
Name:SLATE, TARA KING (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KING
Last Name:SLATE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WILD RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2583
Mailing Address - Country:US
Mailing Address - Phone:303-620-6778
Mailing Address - Fax:
Practice Address - Street 1:614 WILD RIDGE CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2583
Practice Address - Country:US
Practice Address - Phone:303-620-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist