Provider Demographics
NPI:1962633875
Name:HANTMAN, TARA PAULA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:PAULA
Last Name:HANTMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 77TH ST
Mailing Address - Street 2:APT 17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2069
Mailing Address - Country:US
Mailing Address - Phone:212-447-0077
Mailing Address - Fax:
Practice Address - Street 1:201 E 77TH ST
Practice Address - Street 2:APT 17A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2069
Practice Address - Country:US
Practice Address - Phone:212-447-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist