1780824680 NPI number — MRS. TARA NICOLE TROTT M.S., CCC-SLP

Table of content: MRS. TARA NICOLE TROTT M.S., CCC-SLP (NPI 1780824680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780824680 NPI number — MRS. TARA NICOLE TROTT M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROTT
Provider First Name:
TARA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAGING
Provider Other First Name:
TARA
Provider Other Middle Name:
TROTT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780824680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 CARLINA LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78642-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-884-0175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 CARLINA LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78642-0025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-531-9448
Provider Business Practice Location Address Fax Number:
512-988-5459
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  110687 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 14056 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09894354 . This is a "STATE OF TEXAS DRIVERS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 13562404 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14101180 . This is a "ASHA CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z0625 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110687 . This is a "STATE OF TEXAS SLP LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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