Provider Demographics
NPI:1417480393
Name:TANDY THERAPY LLC
Entity Type:Organization
Organization Name:TANDY THERAPY LLC
Other - Org Name:TANDY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDY
Authorized Official - Suffix:
Authorized Official - Credentials:SPL-2712
Authorized Official - Phone:208-981-1111
Mailing Address - Street 1:102 W 11TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9255
Mailing Address - Country:US
Mailing Address - Phone:208-981-1111
Mailing Address - Fax:208-908-0600
Practice Address - Street 1:102 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9255
Practice Address - Country:US
Practice Address - Phone:208-981-1111
Practice Address - Fax:208-908-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217484100Medicaid
ID012288Medicaid