Individual
DR. TARA V SPEVACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., ABPP-CN
Contact information
Practice address
1 CHILDRENS PL, #3S32, SAINT LOUIS, MO 63110-1002
(314) 454-6069
(314) 454-4576
Mailing address
1 CHILDRENS PL, #3S32, SAINT LOUIS, MO 63110-1002
(314) 454-6069
(314) 454-4576
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1999135246
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138995
BCBS
—
01
—
255873
UBH
—
Enumeration date
07/16/2006
Last updated
07/16/2007
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