| Doctor Name: | TARA REGAN BROOME |
| NPI Number: | 1669759056 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 010160 |
| Business Practice Address: | 95 Valley Dr Sound Beach, NY - 117891738 |
| Business Phone Number: | 6317936275 |
| Business Fax Number: | |
| Mailing Address: | 95 Valley Dr, SOUND BEACH |
| State: | NY |
| Postal Code: | 117891738 |
| Phone Number: | 6317936275 |
| Fax Number: | |
| NPI Enumeration Date: | 11/14/2011 |
| NPI Last Update Date: | 11/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 010160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |