Provider Demographics
NPI:1003140799
Name:TASKONAK, TAMBER MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMBER
Middle Name:MARIE
Last Name:TASKONAK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NORTHWEST 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-2000
Mailing Address - Fax:305-243-1283
Practice Address - Street 1:1130 NORTHWEST 14TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-4000
Practice Address - Fax:305-243-1283
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4567235Z00000X
FLSA10277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist