Provider Demographics
NPI:1366996753
Name:FEATHER, TARA NICOLE (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:FEATHER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:WATTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:23 ITASCA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5000
Mailing Address - Country:US
Mailing Address - Phone:864-517-2224
Mailing Address - Fax:
Practice Address - Street 1:50 BEAR DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4458
Practice Address - Country:US
Practice Address - Phone:864-241-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist