Provider Demographics
NPI:1528210093
Name:TANNER, LASHAUNDA BOSTON (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LASHAUNDA
Middle Name:BOSTON
Last Name:TANNER
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 RIVERSCAPE WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9103
Mailing Address - Country:US
Mailing Address - Phone:813-817-2398
Mailing Address - Fax:813-891-6991
Practice Address - Street 1:8811 RIVERSCAPE WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9103
Practice Address - Country:US
Practice Address - Phone:813-817-2398
Practice Address - Fax:813-891-6991
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886483700Medicaid