Provider Demographics
NPI:1528158482
Name:PAGOTTO, TARA A (AUD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:PAGOTTO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-344-4327
Mailing Address - Fax:570-344-7822
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-344-4327
Practice Address - Fax:570-344-7822
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000971L231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter