Individual
TARA KAY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
1211 S 29TH ST, CHICKASHA, OK 73018-9651
(405) 224-0002
(405) 224-0133
Mailing address
1211 S 29TH ST, CHICKASHA, OK 73018-9651
(405) 224-0002
(405) 224-0133
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5066
OK
235Z00000X
Speech-Language Pathologist
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Other
Enumeration date
02/01/2013
Last updated
02/25/2019
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