Provider Demographics
NPI:1871140244
Name:CRIPE, TARA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CRIPE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4041
Mailing Address - Country:US
Mailing Address - Phone:904-535-6083
Mailing Address - Fax:
Practice Address - Street 1:2730 ISABELLA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8002
Practice Address - Country:US
Practice Address - Phone:904-372-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist