Provider Demographics
NPI:1649554924
Name:MCKINNEY, TARA B (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:MCKINNEY
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 1:497 CREAMER LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-8408
Mailing Address - Country:US
Mailing Address - Phone:870-391-3782
Mailing Address - Fax:
Practice Address - Street 1:497 CREAMER LN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8408
Practice Address - Country:US
Practice Address - Phone:870-391-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist