Provider Demographics
NPI:1740589571
Name:BELLER, TAMMY J
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:BELLER
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 1:690 ST PAUL STREET RM 321
Mailing Address - Street 2:ROCHESTER PRESCHOOL PARENT PROGRAM
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605
Mailing Address - Country:US
Mailing Address - Phone:585-328-3360
Mailing Address - Fax:585-324-2705
Practice Address - Street 1:690 ST PAUL STREET RM 321
Practice Address - Street 2:ROCHESTER PRESCHOOL PARENT PROGRAM
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605
Practice Address - Country:US
Practice Address - Phone:585-328-3360
Practice Address - Fax:585-324-2705
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
009808-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist