Basic Information
| Provider Information | |||||||||
| NPI: | 1376766832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANKSLEY | ||||||||
| FirstName: | LASHAWN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSM, MED. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 TYLER WOODS CT | ||||||||
| Address2: | |||||||||
| City: | GROVETOWN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308136303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066276830 | ||||||||
| FaxNumber: | 7066505773 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308309686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | 7064379702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| 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 | SLP005828 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.