Provider Demographics
NPI:1679738686
Name:VYBIRAL, TARA JANE
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JANE
Last Name:VYBIRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-1348
Mailing Address - Country:US
Mailing Address - Phone:724-318-8184
Mailing Address - Fax:
Practice Address - Street 1:3030 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-1348
Practice Address - Country:US
Practice Address - Phone:724-318-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist