1881901452 NPI number — MS. TARA JOY MARSHALL BA, SLPA

Table of content: MS. TARA JOY MARSHALL BA, SLPA (NPI 1881901452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881901452 NPI number — MS. TARA JOY MARSHALL BA, SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
TARA
Provider Middle Name:
JOY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BA, SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSHALL EL-MASRY
Provider Other First Name:
TARA
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA, SLPA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881901452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12409 W INDIAN SCHOOL RD
Provider Second Line Business Mailing Address:
SUITE C306
Provider Business Mailing Address City Name:
AVONDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85392-9502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-935-6040
Provider Business Mailing Address Fax Number:
623-935-6046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12409 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE C306
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85392-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-935-6040
Provider Business Practice Location Address Fax Number:
623-935-6046
Provider Enumeration Date:
09/02/2010

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: 2355S0801X , with the licence number:  SLPA6523 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SLPA6523 . This is a "AZ DEPT. OF HEALTH SERVICES" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com