Provider Demographics
NPI:1235369661
Name:TATE, VIRGINIA CLARE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:CLARE
Last Name:TATE
Suffix:
Gender:F
Credentials:MCD, 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:PO BOX 3519
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3519
Mailing Address - Country:US
Mailing Address - Phone:601-581-1191
Mailing Address - Fax:601-581-3292
Practice Address - Street 1:1502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1552
Practice Address - Country:US
Practice Address - Phone:334-341-4548
Practice Address - Fax:334-341-5168
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist