Provider Demographics
NPI:1366027898
Name:HORVAT, TARA P (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:P
Last Name:HORVAT
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 1:53 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1224
Mailing Address - Country:US
Mailing Address - Phone:201-661-1114
Mailing Address - Fax:
Practice Address - Street 1:31 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7603
Practice Address - Country:US
Practice Address - Phone:973-771-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3531235Z00000X
NJ41YS01131700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist