Provider Demographics
NPI:1194939975
Name:ALTHOFF, TAMARA LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:ALTHOFF
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 230TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005-4415
Mailing Address - Country:US
Mailing Address - Phone:715-263-3307
Mailing Address - Fax:
Practice Address - Street 1:1007 E 14TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1314
Practice Address - Country:US
Practice Address - Phone:612-238-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7189235Z00000X
WI2386-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist