Provider Demographics
NPI:1881901452
Name:MARSHALL, TARA JOY (BA, SLPA)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:JOY
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BA, SLPA
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:JOY
Other - Last Name:MARSHALL EL-MASRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, SLPA
Mailing Address - Street 1:12409 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE C306
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9502
Mailing Address - Country:US
Mailing Address - Phone:623-935-6040
Mailing Address - Fax:623-935-6046
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE C306
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:623-935-6040
Practice Address - Fax:623-935-6046
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA65232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA6523OtherAZ DEPT. OF HEALTH SERVICES