Provider Demographics
NPI:1184878738
Name:TAMBELLINI, CARA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:TAMBELLINI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MIDVALE AVE
Mailing Address - Street 2:APT 409
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6268
Mailing Address - Country:US
Mailing Address - Phone:312-515-0140
Mailing Address - Fax:
Practice Address - Street 1:1300 MIDVALE AVE
Practice Address - Street 2:APT 409
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6268
Practice Address - Country:US
Practice Address - Phone:312-515-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2017-03-31
Deactivation Date:2013-07-24
Deactivation Code:
Reactivation Date:2017-03-31
Provider Licenses
StateLicense IDTaxonomies
CA17566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist