Provider Demographics
NPI:1588818686
Name:TARA B NELSEN, SLP, PC
Entity Type:Organization
Organization Name:TARA B NELSEN, SLP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSEN-DEFALCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-420-6896
Mailing Address - Street 1:189 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1339
Mailing Address - Country:US
Mailing Address - Phone:914-420-6896
Mailing Address - Fax:
Practice Address - Street 1:189 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1339
Practice Address - Country:US
Practice Address - Phone:914-420-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty