Provider Demographics
NPI:1548385347
Name:CULVERHOUSE, TANIA ANN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:ANN
Last Name:CULVERHOUSE
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 1:11420 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-3006
Mailing Address - Country:US
Mailing Address - Phone:727-367-7490
Mailing Address - Fax:
Practice Address - Street 1:11420 4TH STREET EAST
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706
Practice Address - Country:US
Practice Address - Phone:727-367-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist