Basic Information
| Provider Information | |||||||||
| NPI: | 1487783601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANNER | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SPEECH LANG PATH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1404 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135014504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157978552 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 801 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134402129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153396536 | ||||||||
| FaxNumber: | 3152810080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 007259 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.