Individual
TARA PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2758 E MILLENNIUM PL, FAYETTEVILLE, AR 72703-4798
(479) 283-4637
Mailing address
2758 E MILLENNIUM PL, FAYETTEVILLE, AR 72703-4798
(479) 283-4637
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#P8552
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192047721
—
AR
01
—
SP#P8552
ABESPA
AR
Enumeration date
04/19/2012
Last updated
09/27/2012
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