Provider Demographics
NPI:1063131209
Name:DOBRZYN, TAMARA ANN
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:DOBRZYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-9103
Mailing Address - Country:US
Mailing Address - Phone:570-851-8379
Mailing Address - Fax:
Practice Address - Street 1:126 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-9103
Practice Address - Country:US
Practice Address - Phone:570-851-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003880L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist