Provider Demographics
NPI:1336922921
Name:GAHM, TARA JEAN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JEAN
Last Name:GAHM
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 I ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1955
Mailing Address - Country:US
Mailing Address - Phone:707-845-4028
Mailing Address - Fax:
Practice Address - Street 1:164 SHAW AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:CA
Practice Address - Zip Code:95536-9781
Practice Address - Country:US
Practice Address - Phone:707-786-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist