Individual
MS. TARA K JARAMILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1115 N CALIFORNIA ST, SOCORRO, NM 87801-4265
(575) 838-0800
(575) 838-3999
Mailing address
PO BOX 642, SOCORRO, NM 87801-0642
(575) 838-0800
(575) 838-3999
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1487
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00P3051
MEDICAID-ASC
NM
01
—
88722520
MEDICAID PCO
NM
05
—
D4005
—
NM
Enumeration date
02/09/2007
Last updated
05/04/2026
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