Doctor Name: | MRS. TARA GRETCHEN MOUSER |
NPI Number: | 1003019761 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MCDCCCSLP |
License Number: | 112138 |
Business Practice Address: | 505 Court St. Bloomfield, MO - 63825 |
Business Phone Number: | 5735684562 |
Business Fax Number: | 5735684563 |
Mailing Address: | 1321 Buisness Hwy 60 W, DEXTER |
State: | MO |
Postal Code: | 63841 |
Phone Number: | 5736243150 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 112138 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |