Provider Demographics
NPI:1407412653
Name:TANNER, HOWARD FRANKLIN II (MPA, MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:FRANKLIN
Last Name:TANNER
Suffix:II
Gender:M
Credentials:MPA, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4293 KELSEY AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3685
Mailing Address - Country:US
Mailing Address - Phone:517-206-3699
Mailing Address - Fax:
Practice Address - Street 1:102 EAST MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-581-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist