Basic Information
| Provider Information | |||||||||
| NPI: | 1023041324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRANFILL | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 BOGLE ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066791761 | ||||||||
| FaxNumber: | 6066780971 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 BOGLE ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066791761 | ||||||||
| FaxNumber: | 6066780971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 0786 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 000000244102 | 01 | KY | BCBS PROVIDER NUMBER | OTHER |