Tara Gervera, M.S. TSSLD

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

025849 Issued in NY

Practice address

420 Gaffney Dr
Watertown, NY 13601-1823

Phone

(315) 836-1227

Fax

(315) 788-8557

NPI assigned

Jul 15, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1255715637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 GAFFNEY DR",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011823",
            "telephone_number": "315-836-1227",
            "fax_number": "315-788-8557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GAFFNEY DR",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011823",
            "telephone_number": "315-836-1227",
            "fax_number": "315-788-8557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERVERA",
        "first_name": "TARA",
        "credential": "M.S. TSSLD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "025849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "025849",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Itagegnehou Gedamu, DMD
• Genoa Healthcare LLC
• Marnie Genre, O.D.
• Gerald Steven Weinstein
• Gabrielle Nicole Gero, CCC-SLP
• Ashley Lynn Getman-Hubbard, LPN
• Alfred Libero Gianfagna, M.D.
• Joseph C Gianfagna, M.D.
• Alyssa J Gibbs, P.T.
• Samantha May Gilbo, LPN

• Speech-Language Pathologist in Watertown, NY
• Providers in Watertown, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.