Provider Demographics
NPI:1013400670
Name:REITMAN, TARYN
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:REITMAN
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 1:4258 VIA MIRA MONTE
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5134
Mailing Address - Country:US
Mailing Address - Phone:818-309-3420
Mailing Address - Fax:
Practice Address - Street 1:4258 VIA MIRA MONTE
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5134
Practice Address - Country:US
Practice Address - Phone:818-309-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29712OtherSPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID DISPENSERS BOARD
CA12432OtherDEPARTMENT OF CONSUMER AFFAIRS