Basic Information
| Provider Information | |||||||||
| NPI: | 1366622425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONKLIN | ||||||||
| FirstName: | TAMMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 CHURCHLAND RD | ||||||||
| Address2: | |||||||||
| City: | SAUGERTIES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124774649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456651219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 206 MARYLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396483926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 103318 | TX | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 016417-01 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.