1639543234 NPI number — TARA JEAN HOWARD M.A., CCC-A

Table of content: TARA JEAN HOWARD M.A., CCC-A (NPI 1639543234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639543234 NPI number — TARA JEAN HOWARD M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
TARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UNDERKOFLER
Provider Other First Name:
TARA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639543234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 S COLLEGE ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36832-7209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-209-6661
Provider Business Mailing Address Fax Number:
334-209-6663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 GATEWAY DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-6872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-745-1635
Provider Business Practice Location Address Fax Number:
334-745-1639
Provider Enumeration Date:
11/19/2015

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: 231H00000X , with the licence number:  1121A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: AUD003761 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 1121A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: AUD003761 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12084594 . This is a "ASHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AUD003761 . This is a "STATE LICENSE GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 13658879 . This is a "CAQH PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1121A . This is a "STATE LICENSE AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".