Basic Information
| Provider Information | |||||||||
| NPI: | 1932549136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANT | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Credential: | MS, SLP-CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412307 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142944050 | ||||||||
| FaxNumber: | 6317608306 | ||||||||
| Practice Location | |||||||||
| Address1: | 3509 GRANBY ST STE B | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235041312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574238885 | ||||||||
| FaxNumber: | 7574238886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2013 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202010016 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 10408 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.