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NPI Code Detail

MEDICARE: TARA CRIPE M.S., CCC-SLP

MEDICARE: TARA CRIPE M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871140244
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA CRIPE M.S., CCC-SLP
Provider Business Mailing Address
First Line : 551 DAVID ST
Second Line :
City : ATLANTIC BEACH
State : FL
Zip : 32233-4041
Country : US
Telephone Number : 904-535-6083
Fax Number :
Provider Business Practice Location Address
First Line : 2730 ISABELLA BLVD STE 10
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-8002
Country : US
Telephone Number : 904-372-4070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2019
Last Update Date : 08/21/2019

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Directions to “ TARA CRIPE M.S., CCC-SLP” Practice Location

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