Provider Demographics
NPI:1467409086
Name:DUSHACK, TAMMI (CCC)
Entity Type:Individual
Prefix:MISS
First Name:TAMMI
Middle Name:
Last Name:DUSHACK
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MARGUERITE AVE.
Mailing Address - Street 2:UNIT C
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625
Mailing Address - Country:US
Mailing Address - Phone:949-365-6415
Mailing Address - Fax:
Practice Address - Street 1:328 MARGUERITE AVE
Practice Address - Street 2:UNIT C
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-3083
Practice Address - Country:US
Practice Address - Phone:949-365-6415
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist