Provider Demographics
NPI:1376620245
Name:TESSANDORI, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:TESSANDORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE STE 105C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1450
Mailing Address - Country:US
Mailing Address - Phone:270-691-2699
Mailing Address - Fax:270-691-2677
Practice Address - Street 1:2200 E PARRISH AVE STE 105C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1450
Practice Address - Country:US
Practice Address - Phone:270-691-2699
Practice Address - Fax:270-691-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist