Most Relevant Information
Provider Data
| NPI Number: | 1003019761 |
| Provider Name: | TARA GRETCHEN MOUSER MCDCCCSLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 112138 |
Most Important Dates
| Enumeration Date: | 06/08/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
505 COURT ST.
BLOOMFIELD
MO
63825
Practice Location Phone/Fax
| Phone: | 5735684562 |
| Fax: | 5735684563 |
Provider Mailing Location
1321 BUISNESS HWY 60 W
DEXTER
MO
63841
Provider Mailing Phone/Fax
| Phone: | 5736243150 |
| Fax: |