Tara Grissom, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4782 Issued in LA

Practice address

1011 N Causeway Blvd Ste 25
Mandeville, LA 70471-3282

Phone

(985) 626-8403

NPI assigned

Aug 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Speech Language & Learning Center Inc

  • Speech-Language Pathologist
  • Mandeville, LA
  • NPI 1093892721
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1023783255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 PELICAN RIDGE DR",
            "city": "MADISONVILLE",
            "state": "LA",
            "postal_code": "704479248",
            "telephone_number": "985-264-6856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N CAUSEWAY BLVD STE 25",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713282",
            "telephone_number": "985-626-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "TARA",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "4782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darreon Guy Griffin, MSW, LMSW
• Kala Leighan Griffin
• Sharon Renee Griffin
• Orton F Grinnell, CFA
• Garic Grisbaum, M.D.
• Katherine B Gristina, MS, LOTR, C/NDT
• Katherine Lea Gristina, CCC-SLP
• Bruce Allen Groom, MD
• Lisa Gros, RN
• Charlotte N Groth, RN

• Speech-Language Pathologist in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.