Provider Demographics
NPI:1477708832
Name:GALLAGHER, TARA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:GALLAGHER
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 1:1 CASTLE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1827
Mailing Address - Country:US
Mailing Address - Phone:914-933-0667
Mailing Address - Fax:
Practice Address - Street 1:1 CASTLE VIEW CT
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1827
Practice Address - Country:US
Practice Address - Phone:914-933-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58014893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist