Provider Demographics
NPI:1639650419
Name:TALLERICO, TARYN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:TALLERICO
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 1:7114 DEAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7135
Mailing Address - Country:US
Mailing Address - Phone:614-715-1715
Mailing Address - Fax:
Practice Address - Street 1:6000 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1492
Practice Address - Country:US
Practice Address - Phone:614-734-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist