Most Relevant Information
Provider Data
| NPI Number: | 1003447996 |
| Provider Name: | TAMARA M VANDENBROUCKE SLPA |
| Entity Type: | Individual |
| Taxonomy Code: | 2355S0801X |
| Specialty: | Specialist/Technologist |
| License Number: | 5973 |
Most Important Dates
| Enumeration Date: | 01/29/2020 |
| Last Updated: | 01/29/2020 |
Provider Practice Location
5567 RESEDA BLVD STE 107
TARZANA
CA
913562648
Practice Location Phone/Fax
| Phone: | 9098378029 |
| Fax: |
Provider Mailing Location
13047 MOORPARK ST APT 2
STUDIO CITY
CA
916045030
Provider Mailing Phone/Fax
| Phone: | 9098378029 |
| Fax: |