Provider Demographics
NPI:1275848731
Name:TARAKOFSKY, DEBRA P (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:P
Last Name:TARAKOFSKY
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 1:11085 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6488
Mailing Address - Country:US
Mailing Address - Phone:954-578-4000
Mailing Address - Fax:954-578-4948
Practice Address - Street 1:4572 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7987
Practice Address - Country:US
Practice Address - Phone:954-578-4000
Practice Address - Fax:954-578-4948
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist