Kellie Tarra, MS, CCC-SLP/L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14147284

Practice address

742 Essington Rd
Joliet, IL 60435-4912

Phone

(815) 469-1500

NPI assigned

Oct 17, 2017

Last updated

May 6, 2022By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

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

• Westside Childrens Therapy

  • Physical Therapist
  • Joliet, IL
  • NPI 1972783900

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1356852362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 ESSINGTON RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604354912",
            "telephone_number": "815-469-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 ESSINGTON RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604354912",
            "telephone_number": "815-469-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARRA",
        "first_name": "KELLIE",
        "credential": "MS, CCC-SLP/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": "14147284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146013793",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Tan, PT
• Pankaj S Tanna, MD
• Ross Tannebaum, MD
• Heather Katherine Taras, M.D.
• Mona Tareen, M.D.
• Jessica Lauren Tarwater
• Gerardo Tavera, LMSW
• David B Taylor, DC
• TC Equipment LLC
• Semere Tedla, M.D.

• Speech-Language Pathologist in Joliet, IL
• Providers in Joliet, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.