Basic Information
| Provider Information | |||||||||
| NPI: | 1568077915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANSECO | ||||||||
| FirstName: | LEA ANGELICA | ||||||||
| MiddleName: | BOLLOZOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5440 ADAMSTOWN COMMONS DR | ||||||||
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| City: | ADAMSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217108922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435199810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 197 THOMAS JOHNSON DR STE B | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667273422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2020 | ||||||||
| LastUpdateDate: | 09/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.