Provider Demographics
NPI:1952556987
Name:BOTTONE, TARA SUSAN (MA,CCC-SLP,TSHH)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:SUSAN
Last Name:BOTTONE
Suffix:
Gender:F
Credentials:MA,CCC-SLP,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 GREENWOOD AVE
Mailing Address - Street 2:APT 2 S
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1349
Mailing Address - Country:US
Mailing Address - Phone:718-909-5433
Mailing Address - Fax:
Practice Address - Street 1:440 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1704
Practice Address - Country:US
Practice Address - Phone:718-260-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist