Provider Demographics
NPI:1003173899
Name:PILGRIM, TAMMY L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HARE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1020
Mailing Address - Country:US
Mailing Address - Phone:843-813-9654
Mailing Address - Fax:
Practice Address - Street 1:1510 COLLINGWOOD RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1605
Practice Address - Country:US
Practice Address - Phone:703-765-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist