Provider Demographics
NPI:1750898375
Name:ORDWAY, TARA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ORDWAY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 SHOREHAM PL STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5927
Mailing Address - Country:US
Mailing Address - Phone:858-272-2662
Mailing Address - Fax:
Practice Address - Street 1:5075 SHOREHAM PL STE 115
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5927
Practice Address - Country:US
Practice Address - Phone:858-272-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2025-05-13
Deactivation Date:2025-03-14
Deactivation Code:
Reactivation Date:2025-05-12
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30928103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst