Provider Demographics
NPI:1104351832
Name:TATARA, DANIELLE RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:TATARA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:659 MARYLAND AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:SHADYSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1940
Mailing Address - Country:US
Mailing Address - Phone:412-627-1329
Mailing Address - Fax:
Practice Address - Street 1:916 HICKORY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2248
Practice Address - Country:US
Practice Address - Phone:814-696-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist