MEDICARE: MRS. TARA ANN BOETTCHER MS, 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
1	235Z00000X	Speech-Language Pathologist	101905	TX

General Provider Information

NPI Number	:	1912926478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA ANN BOETTCHER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 174
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-0107
Country	:	US
Telephone Number	:	682-400-8132
Fax Number	:	682-400-8235

Provider Business Practice Location Address
First Line	:	1285 N MAIN ST STE 101-1
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1511
Country	:	US
Telephone Number	:	682-400-8132
Fax Number	:	682-400-8235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/17/2025

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Directions to “ MRS. TARA ANN BOETTCHER MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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