Provider Demographics
NPI:1023636206
Name:HUTH-GARGIULO, TAMARA J (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:HUTH-GARGIULO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:J
Other - Last Name:HUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:31 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3701
Mailing Address - Country:US
Mailing Address - Phone:201-478-3534
Mailing Address - Fax:
Practice Address - Street 1:31 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3701
Practice Address - Country:US
Practice Address - Phone:201-478-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00367100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00367100OtherNJ LICENSE FOR SPEECH LANGUAGE PATHOLOGY