Healthcare Provider Details

I. General information

NPI: 1639543234
Provider Name (Legal Business Name): TARA JEAN HOWARD M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA JEAN UNDERKOFLER M.A., CCC-A

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 GATEWAY DR STE D
OPELIKA AL
36801-6872
US

IV. Provider business mailing address

1100 S COLLEGE ST STE 105
AUBURN AL
36832-7209
US

V. Phone/Fax

Practice location:
  • Phone: 334-745-1635
  • Fax: 334-745-1639
Mailing address:
  • Phone: 334-209-6661
  • Fax: 334-209-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1121A
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003761
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1121A
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: