Individual
KATIE TACKABERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
10 GAIL CT, SPARTA, NJ 07871-3439
(973) 579-6980
Mailing address
1706 WHITE PINE CT, CEDAR KNOLLS, NJ 07927-1336
(973) 270-3484
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00884700
NJ
Other
Enumeration date
10/04/2019
Last updated
10/04/2019
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