Provider Demographics
NPI:1154400141
Name:HOLT, TARA L (SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:HOLT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:RENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2000 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8801
Mailing Address - Country:US
Mailing Address - Phone:972-422-6968
Mailing Address - Fax:972-422-6575
Practice Address - Street 1:2000 N CENTRAL EXPY
Practice Address - Street 2:SUITE 113
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8801
Practice Address - Country:US
Practice Address - Phone:972-422-6968
Practice Address - Fax:972-422-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist