Provider Demographics
NPI:1962799338
Name:MINNIX-HARMON, TARA JANAE (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JANAE
Last Name:MINNIX-HARMON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 NEW HOPE ROAD
Mailing Address - Street 2:SUITE #19
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2272
Mailing Address - Country:US
Mailing Address - Phone:304-487-2487
Mailing Address - Fax:304-431-3367
Practice Address - Street 1:508 NEW HOPE ROAD
Practice Address - Street 2:SUITE #19
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2272
Practice Address - Country:US
Practice Address - Phone:304-487-2487
Practice Address - Fax:304-431-3367
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0276231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist