Provider Demographics
NPI:1881900884
Name:JAMES, TARA L (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:JAMES
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:PO BOX 83504
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3504
Mailing Address - Country:US
Mailing Address - Phone:225-329-6026
Mailing Address - Fax:
Practice Address - Street 1:36428 MANCHAC TRACE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3264
Practice Address - Country:US
Practice Address - Phone:225-329-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2023-05-04
Deactivation Date:2012-07-25
Deactivation Code:
Reactivation Date:2023-05-04
Provider Licenses
StateLicense IDTaxonomies
LA4769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist