Provider Demographics
NPI:1679834030
Name:TARTAKOFF, KAREN (AUD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TARTAKOFF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:HOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:43 BAXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1823
Practice Address - Country:US
Practice Address - Phone:207-775-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP2159231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist