Provider Demographics
NPI:1306162144
Name:PAUL, TAMARA J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:PAUL
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 1:3089 WADDELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6407
Mailing Address - Country:US
Mailing Address - Phone:561-351-4873
Mailing Address - Fax:
Practice Address - Street 1:1201 US HIGHWAY 1
Practice Address - Street 2:SUITE # 215
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3550
Practice Address - Country:US
Practice Address - Phone:561-776-8612
Practice Address - Fax:561-623-7515
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist