Basic Information
| Provider Information | |||||||||
| NPI: | 1396052395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATMAN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | WEST | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 THORNCLIFF DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283035258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104845539 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 PURDUE DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104865000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2010 | ||||||||
| LastUpdateDate: | 09/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 4319 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.