Provider Demographics
NPI:1457090854
Name:HIGGINBOTHAM, TAHNEE ANNE (SLP-A)
Entity Type:Individual
Prefix:MRS
First Name:TAHNEE
Middle Name:ANNE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30008 N 73RD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3068
Mailing Address - Country:US
Mailing Address - Phone:623-670-1773
Mailing Address - Fax:
Practice Address - Street 1:30008 N 73RD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3068
Practice Address - Country:US
Practice Address - Phone:623-670-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA137872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant