Provider Demographics
NPI:1265609754
Name:RATZLAFF, TARA DAPHNE (SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DAPHNE
Last Name:RATZLAFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:DAPHNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5917 S NATURE RUN PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5233
Mailing Address - Country:US
Mailing Address - Phone:605-212-2765
Mailing Address - Fax:
Practice Address - Street 1:5917 S NATURE RUN PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5233
Practice Address - Country:US
Practice Address - Phone:605-212-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist