Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1871906891 Individual Practitioner Female Practitioner

Tara Wittrock , CCC, SLP

Speech-Language Pathologist • Moose Lake, MN

Professional Overview & Biography Verified Profile Summary

Tara Wittrock, CCC, SLP is a registered healthcare professional specializing in Speech-Language Pathologist in Moose Lake, MN. Practice services are available at 4791 COUNTY ROAD 10 STE 102 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4791 County Road 10 Ste 102

Moose Lake, MN 557679221

Telephone 2184852020
Fax 2184852044
Associated Practice Facility / Clinic
🏢 Therapy Partners, Inc. Facility NPI 1407809494

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Moose Lake, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.7 Yrs
Regional Practice Density
5 Specialists

Practicing in Moose Lake, MN (3097 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-08-14
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License MN 9592

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Secondary Practice Locations

407 E 3rd St

Duluth, MN 55805

Phone: 2187864000

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

12 Associated Practitioners
Dr. Allie Hakamaki , DPT

Physical Therapist

NPI 1174198170

Doctor of Physical Therapy

Allyson Loupe , PT

Physical Therapist

NPI 1215367412

Physical Therapist

Jessica Johnson , MPT

Physical Therapist

NPI 1275800021

Master of Physical Therapy

Lynn Folsted , PT

Physical Therapist

NPI 1396919031

Physical Therapist

Leann Poirier , OTR, L

Occupational Therapist

NPI 1558058909

Occupational Therapist Registered, L

Amy Forbes , PT

Physical Therapist

NPI 1700118197

Physical Therapist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events
📍
Updated Practice Location August 14, 2023

Registered at 4791 COUNTY ROAD 10 STE 102, MOOSE LAKE, MN 557679221 (Tel: 2184852020)

📍
Updated Business Mailing Address August 14, 2023

Registered at 1939 MINNEHAHA AVE W STE 300, SAINT PAUL, MN 551041033 (Tel: 6517484338)

📍
Updated Practice Location May 18, 2021

Registered at 4570 COUNTY ROAD 61, MOOSE LAKE, MN 557679401 (Tel: 2184852020)

📍
Updated Business Mailing Address May 18, 2021

Registered at 7581 9TH ST N STE 100, OAKDALE, MN 551286635 (Tel: 6517484338)

📍
Updated Practice Location October 03, 2018

Registered at 407 E 3RD ST, DULUTH, MN 55805 (Tel: 2187864000)

📍
Updated Business Mailing Address October 03, 2018

Registered at 1702 UNIVERSITY DR S, FARGO, ND 581034940

👤
Provider Name / Credentials Updated October 03, 2018

Recorded as TARA WITTROCK, CCC/SLP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 03, 2018

Speech-Language Pathologist (License #9592 in MN)

NPI Profile Active June 06, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location June 06, 2014

Registered at 1955 N FEDERAL HWY, POMPANO BEACH, FL 330621028 (Tel: 9545802520)

📍
Updated Business Mailing Address June 06, 2014

Registered at 6340 WEDGEWOOD TER, TAMARAC, FL 333213573

👤
Provider Name / Credentials Updated June 06, 2014

Recorded as TARA DETTLE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 06, 2014

Speech-Language Pathologist (License #SZ6665 in FL)

🟢
Initial NPI Registration & Enumeration June 06, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1871906891
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 06, 2014
Last Update: August 14, 2023
Sole Proprietor: No

Mailing Address

1939 Minnehaha Ave W Ste 300

Saint Paul, MN 551041033

Phone: 6517484338

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.