Provider Demographics
NPI:1659665875
Name:VEHORN, TARA LYNN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:VEHORN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:12725 SOUTHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-8355
Mailing Address - Country:US
Mailing Address - Phone:937-726-4370
Mailing Address - Fax:
Practice Address - Street 1:121 S OPERA ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2057
Practice Address - Country:US
Practice Address - Phone:937-599-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist