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General NPI Number Information
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NPI Number | 1134981418
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Entity Type | Organization
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Legal Business Name | SPEECH WITH TARA, LLC
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 217 POCAHONTAS LN
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City | DEFOREST
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State | WI
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Zip | 53532-1051
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Country | US
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Telephone | 715-529-7736
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Fax |
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Provider Business Mailing Address
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Address Line | 217 POCAHONTAS LN
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City | DEFOREST
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State | WI
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Zip | 53532-1051
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Country | US
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Telephone | 715-529-7736
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Fax |
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Authorized Official
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Title or Position | CCC-SPEECH LANGUAGE PATHOLOGIST
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Name | TARA DAHLKE
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Credential | B.S., M.S., M.A.
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Telephone | 608-571-5737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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