Provider Demographics
NPI:1831553478
Name:GAINES, TARA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MA 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 6893
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-6893
Mailing Address - Country:US
Mailing Address - Phone:775-298-1441
Mailing Address - Fax:
Practice Address - Street 1:800 SOUTHWOOD BLVD STE 207
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-7475
Practice Address - Country:US
Practice Address - Phone:775-298-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist