1932549136 NPI number — COURTNEY TANT MS, SLP-CCC

Table of content: COURTNEY TANT MS, SLP-CCC (NPI 1932549136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932549136 NPI number — COURTNEY TANT MS, SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANT
Provider First Name:
COURTNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, SLP-CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932549136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-294-4050
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3509 GRANBY ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23504-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-423-8885
Provider Business Practice Location Address Fax Number:
757-423-8886
Provider Enumeration Date:
07/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202010016 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 10408 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)