Provider Demographics
NPI:1639687536
Name:ROBINSON, TARA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:DE BERTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 S 23RD ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1831
Practice Address - Country:US
Practice Address - Phone:973-851-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00626800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12146008OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
41YS00626800OtherSPEECH LANGUAGE PATHOLOGIST LICENSE