Provider Demographics
NPI:1144500240
Name:TARNER, KATHRYN ROSE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:TARNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VAN ARSDALE PL
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2257
Mailing Address - Country:US
Mailing Address - Phone:516-313-9240
Mailing Address - Fax:
Practice Address - Street 1:2420 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3444
Practice Address - Country:US
Practice Address - Phone:718-469-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029719610001Medicaid