Provider Demographics
NPI:1871541888
Name:ADAMS, TARA CRAIG (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CRAIG
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:629 BRANCH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-4836
Mailing Address - Country:US
Mailing Address - Phone:870-674-4061
Mailing Address - Fax:
Practice Address - Street 1:355 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2537
Practice Address - Country:US
Practice Address - Phone:864-595-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2069235Z00000X
SCSLP.4636 SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149797721Medicaid