Provider Demographics
NPI:1710235163
Name:WERNER, TARA JOANN (MS)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JOANN
Last Name:WERNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-2324
Mailing Address - Country:US
Mailing Address - Phone:570-262-2475
Mailing Address - Fax:
Practice Address - Street 1:4578 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8670
Practice Address - Country:US
Practice Address - Phone:732-804-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL10948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist