Provider Demographics
NPI:1063673796
Name:LIGHT, TARYN DANEE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MS
First Name:TARYN
Middle Name:DANEE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 BROOKHOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-8904
Mailing Address - Country:US
Mailing Address - Phone:409-617-1052
Mailing Address - Fax:409-786-1278
Practice Address - Street 1:4150 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-8244
Practice Address - Country:US
Practice Address - Phone:409-951-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist