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Individual

TARA DENAE LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CF-SLP

Contact information

Practice address
518 N HAMPTON AVE, REPUBLIC, MO 65738-1323
(417) 732-3605
Mailing address
518 N HAMPTON AVE, REPUBLIC, MO 65738-1323
(417) 732-3605

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2022026198
MO

Other

Enumeration date
08/18/2022
Last updated
08/18/2022
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