Tara Moxham, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202007194 Issued in VA

Practice address

4400 Lumberjack LN
Glen Allen, VA 23060-6275

Phone

(321) 952-1818

NPI assigned

Oct 11, 2013

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 Arts

State licenses

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

{
    "created_epoch": "1381449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381449600000",
    "number": "1902233737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 LUMBERJACK LN",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606275",
            "telephone_number": "321-952-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 LUMBERJACK LN",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606275",
            "telephone_number": "321-952-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOXHAM",
        "first_name": "TARA",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-11",
        "last_updated": "2013-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202007194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; 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.