Provider Demographics
NPI:1942938477
Name:DITZIAN, TAMAR (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:DITZIAN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 N HIMES AVE APT 911
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-8305
Mailing Address - Country:US
Mailing Address - Phone:352-213-4904
Mailing Address - Fax:
Practice Address - Street 1:1524 S EAST AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2324
Practice Address - Country:US
Practice Address - Phone:941-365-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist