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Individual

MRS. TARA PEGRAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., CCC-SLP

Contact information

Practice address
8505 E VALLEY VIEW RD, SCOTTSDALE, AZ 85250-6768
(480) 484-7700
Mailing address
8505 E VALLEY VIEW RD, SCOTTSDALE, AZ 85250-6768
(480) 484-7700

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1641
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
692823
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
02/07/2007
Last updated
07/08/2007
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