Healthcare Provider Details

I. General information

NPI: 1245893288
Provider Name (Legal Business Name): TARA ENGLAND MA, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 HIGHWAY 3444
ANNVILLE KY
40402-8245
US

IV. Provider business mailing address

1963 BROOKHAVEN DR
LONDON KY
40744-8344
US

V. Phone/Fax

Practice location:
  • Phone: 606-364-5197
  • Fax:
Mailing address:
  • Phone: 606-594-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number139720
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: