Provider Demographics
NPI:1750727434
Name:RECK, TASHA (AUD)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:RECK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:GOODWIN-RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-969-4950
Practice Address - Fax:610-969-4960
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006295231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAT006295OtherSTATE LICENSE NUMBER