Provider Demographics
NPI:1871689661
Name:KALBACH, TARA MAUREEN (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MAUREEN
Last Name:KALBACH
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:MAUREEN
Other - Last Name:STYGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:12084 LAKE CYPRESS CIR
Mailing Address - Street 2:APT. J309
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7055
Mailing Address - Country:US
Mailing Address - Phone:407-996-1581
Mailing Address - Fax:407-996-1581
Practice Address - Street 1:1002 S DILLARD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-905-8908
Practice Address - Fax:407-905-8958
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist