Provider Demographics
NPI:1174995468
Name:STICHLER, TARA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:STICHLER
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 1:520 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2200
Mailing Address - Country:US
Mailing Address - Phone:772-321-4823
Mailing Address - Fax:
Practice Address - Street 1:520 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2200
Practice Address - Country:US
Practice Address - Phone:618-667-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.016694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist