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NPI Code Detail

MEDICARE: TARA LUTHER SLP-CCC

MEDICARE: TARA LUTHER SLP-CCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist4714TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14714OTHERTNTN HL

General Provider Information

NPI Number : 1174958748
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA LUTHER SLP-CCC
Provider Business Mailing Address
First Line : PO BOX 8114
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37414-0114
Country : US
Telephone Number : 423-622-1551
Fax Number : 877-856-7133
Provider Business Practice Location Address
First Line : 1400 E SPRING ST
Second Line :
City : COOKEVILLE
State : TN
Zip : 38506-4313
Country : US
Telephone Number : 423-622-1551
Fax Number : 877-856-7133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2013
Last Update Date : 09/04/2019

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Directions to “ TARA LUTHER SLP-CCC” Practice Location

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