Provider Demographics
NPI:1134496631
Name:TRAVERS, TARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5046
Mailing Address - Country:US
Mailing Address - Phone:914-376-8320
Mailing Address - Fax:
Practice Address - Street 1:118 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-5046
Practice Address - Country:US
Practice Address - Phone:914-376-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist