MEDICARE: MRS. TARA BEILKE SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22003558A	IN

General Provider Information

NPI Number	:	1780909598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA BEILKE SLP

Provider Business Mailing Address
First Line	:	12712 MARSH LANDING PKWY
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-8552
Country	:	US
Telephone Number	:	219-374-6117
Fax Number	:	219-374-6117

Provider Business Practice Location Address
First Line	:	12712 MARSH LANDING PKWY
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-8552
Country	:	US
Telephone Number	:	219-374-6117
Fax Number	:	219-374-6117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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Directions to “ MRS. TARA BEILKE SLP” Practice Location

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