Provider Demographics
NPI:1235396763
Name:OSORIO, TANI C (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANI
Middle Name:C
Last Name:OSORIO
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 1:520 SOUTHWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2641
Mailing Address - Country:US
Mailing Address - Phone:910-551-3337
Mailing Address - Fax:910-864-2705
Practice Address - Street 1:3882 SAND DUNE CT
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3210
Practice Address - Country:US
Practice Address - Phone:910-551-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7846235Z00000X
CA31490235Z00000X
FLSA11272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist