Healthcare Provider Details

I. General information

NPI: 1780061077
Provider Name (Legal Business Name): TARA BECK SLP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S DUNN AVE APT 304
FAYETTEVILLE AR
72701
US

IV. Provider business mailing address

1010 S DUNN AVE APT 304
FAYETTEVILLE AR
72701
US

V. Phone/Fax

Practice location:
  • Phone: 816-289-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA BECK
Title or Position: SPEECH PATHOLOGIST
Credential:
Phone: 816-289-6808