Provider Demographics
NPI:1003938317
Name:FONTENOT, TANICIA LANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TANICIA
Middle Name:LANE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586
Mailing Address - Country:US
Mailing Address - Phone:337-599-2255
Mailing Address - Fax:337-639-4342
Practice Address - Street 1:9025 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-599-2255
Practice Address - Fax:337-639-4342
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist