Provider Demographics
NPI:1043554447
Name:TANKERSLEY, EMILY LAUREN (SLP,A)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:TANKERSLEY
Suffix:
Gender:F
Credentials:SLP,A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8406
Mailing Address - Country:US
Mailing Address - Phone:870-931-4200
Mailing Address - Fax:870-931-4201
Practice Address - Street 1:3214 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8406
Practice Address - Country:US
Practice Address - Phone:870-931-4200
Practice Address - Fax:870-931-4201
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR# 13-001235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR#13-001OtherSLP,A