Provider Demographics
NPI:1124202858
Name:TACHE, MARILYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:TACHE
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 1:3901 NORTH 40TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6237
Mailing Address - Country:US
Mailing Address - Phone:954-882-8767
Mailing Address - Fax:
Practice Address - Street 1:3901 NORTH 40TH AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6237
Practice Address - Country:US
Practice Address - Phone:954-882-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist