Provider Demographics
NPI:1427201664
Name:TACKLER, JULIET P (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:P
Last Name:TACKLER
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 1:7 MERITT CT
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2701
Mailing Address - Country:US
Mailing Address - Phone:914-232-5032
Mailing Address - Fax:
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:BLYTHEDALE CHILDREN'S HOSPITAL
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-2701
Practice Address - Country:US
Practice Address - Phone:914-592-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012669-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist