Healthcare Provider Details

I. General information

NPI: 1639414535
Provider Name (Legal Business Name): TARA R BARON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TARA R BROOKS

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 FINLEY RD STE 101
DOWNERS GROVE IL
60515-1394
US

IV. Provider business mailing address

574 HIAWATHA DR
CAROL STREAM IL
60188-1616
US

V. Phone/Fax

Practice location:
  • Phone: 630-792-1800
  • Fax:
Mailing address:
  • Phone: 847-209-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3694418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: