Provider Demographics
NPI:1225740483
Name:LIONETTI, TARA JESSICA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JESSICA
Last Name:LIONETTI
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 1:258 HIGHLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1344
Mailing Address - Country:US
Mailing Address - Phone:908-619-6366
Mailing Address - Fax:
Practice Address - Street 1:140 GOULD ST STE 290
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2397
Practice Address - Country:US
Practice Address - Phone:781-400-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78383-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist