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General NPI Number Information
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NPI Number | 1558815795
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Entity Type | Individual
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Provider Name | TARA GRANGER
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 6881 CIRCLECREEK DR
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City | PINELLAS PARK
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State | FL
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Zip | 33781-4802
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Country | US
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Telephone | 678-836-4685
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Fax |
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Provider Business Mailing Address
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Address Line | 6881 CIRCLECREEK DR
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City | PINELLAS PARK
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State | FL
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Zip | 33781-4802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 24586
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17317
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License Number State | FL
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