Provider Demographics
NPI:1174957575
Name:HILL, TARA CHAE
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:CHAE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:CHAE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 SHAKER MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9029
Mailing Address - Country:US
Mailing Address - Phone:270-779-2502
Mailing Address - Fax:
Practice Address - Street 1:261 SHAKER MILL RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9029
Practice Address - Country:US
Practice Address - Phone:270-779-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13-004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist