Provider Demographics
NPI:1578730099
Name:DOMBACH, TARA LYNN (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:DOMBACH
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 1:900 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3272
Mailing Address - Country:US
Mailing Address - Phone:717-293-7279
Mailing Address - Fax:717-735-3106
Practice Address - Street 1:900 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3272
Practice Address - Country:US
Practice Address - Phone:717-293-7279
Practice Address - Fax:717-735-3106
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist