Provider Demographics
NPI:1740506146
Name:CARTER, TASHA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:CARTER
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 1:722 AVONDALE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5829
Mailing Address - Country:US
Mailing Address - Phone:301-646-0304
Mailing Address - Fax:
Practice Address - Street 1:722 AVONDALE HILLS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5829
Practice Address - Country:US
Practice Address - Phone:301-646-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12057433OtherAMERICAN SPEECH AND HEARING ASSOCIATION
GASLP007594OtherGEORGIA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY