Provider Demographics
NPI:1902473200
Name:ELSE, TAMARA MONET
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MONET
Last Name:ELSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5705
Mailing Address - Country:US
Mailing Address - Phone:623-329-5955
Mailing Address - Fax:
Practice Address - Street 1:9299 W OLIVE AVE STE 311
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8381
Practice Address - Country:US
Practice Address - Phone:623-215-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA130172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant