Provider Demographics
NPI:1144470006
Name:PETROWSKY GORMAN, TAMARA ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:PETROWSKY GORMAN
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 1:50 BECKWITH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5927
Mailing Address - Country:US
Mailing Address - Phone:719-671-9247
Mailing Address - Fax:
Practice Address - Street 1:4190 BARDOT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7507
Practice Address - Country:US
Practice Address - Phone:719-671-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001116235Z00000X
01129463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist