Active NPI
Tara Renee Carr, CCC-SLP
- Speech-Language Pathologist
- Peoria, IL
National Provider Identifier
1831669555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 10879
- Practice address
- 3611 N Rochelle LN
Peoria, IL 61604-1038 - Phone
- (618) 530-2147
- NPI assigned
- Nov 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 10879 | OH | Primary |
Addresses
Primary practice location
3611 N Rochelle LN
Peoria, IL 61604-1038
Mailing address
101 W Forest Ave
East Peoria, IL 61611-3032
Other names 1
- Tara Renee Mans
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10879 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543190400000",
"number": "1831669555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 W FOREST AVE",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616113032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3611 N ROCHELLE LN",
"city": "PEORIA",
"state": "IL",
"postal_code": "616041038",
"telephone_number": "618-530-2147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARR",
"first_name": "TARA",
"middle_name": "RENEE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-26",
"last_updated": "2018-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "10879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TARA",
"last_name": "MANS",
"middle_name": "RENEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.