Provider Demographics
NPI:1669820908
Name:THOMAS, TARA LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:THOMAS
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:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-6125
Mailing Address - Country:US
Mailing Address - Phone:417-388-8264
Mailing Address - Fax:
Practice Address - Street 1:710 LYON ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1700
Practice Address - Country:US
Practice Address - Phone:417-359-7000
Practice Address - Fax:417-359-7004
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist