Individual
TARA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
123 W CASCADE WAY, SPOKANE, WA 99208-6017
(509) 624-3115
Mailing address
123 W CASCADE WAY, SPOKANE, WA 99208-6017
(509) 624-3115
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60813836
WA
235Z00000X
Speech-Language Pathologist
TSLP-3021
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL60813836
SPEECH LANGUAGE PATHOLOGY LICENSE
WA
Enumeration date
07/21/2016
Last updated
08/08/2022
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