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DR. TARA V SPEVACK PH.D., ABPP-CN

Clinical Neuropsychologist

Saint Louis, Missouri

Provider NPI: 1588681472

Provider Information:
DR. TARA V SPEVACK PH.D., ABPP-CN
Gender: F
Not Sole Proprietor

Practice Location:
1 CHILDRENS PL #3S32 SAINT LOUIS, MO 63110 US
Tel: 314-454-6069  Fax: 314-454-4576

Business Mailing Address:
1 CHILDRENS PL #3S32 SAINT LOUIS, MO 63110 US
Tel: 314-454-6069  Fax: 314-454-4576

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MO1999135246

Other Provider Identifiers:

IssuerNumberStateType
UBH25587301
BCBS13899501
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS MO - Page 1



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