Provider Demographics
NPI:1457179798
Name:GARTENBERG, TARA ROCHELLE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ROCHELLE
Last Name:GARTENBERG
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 1:24244 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1580
Mailing Address - Country:US
Mailing Address - Phone:973-796-8859
Mailing Address - Fax:
Practice Address - Street 1:3570 WARRENSVILLE CENTER RD STE 106
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5226
Practice Address - Country:US
Practice Address - Phone:973-796-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist