Provider Demographics
NPI:1174876684
Name:MERLA, TARA M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:MERLA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WHELAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:239 N MIDDLETOWN RD
Mailing Address - Street 2:APT A
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1138
Mailing Address - Country:US
Mailing Address - Phone:631-662-6528
Mailing Address - Fax:
Practice Address - Street 1:59 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-210-7124
Practice Address - Fax:203-210-7126
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0221888235Z00000X
NJ41YS00814100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist