Provider Demographics
NPI:1568077915
Name:TANSECO, LEA ANGELICA BOLLOZOS
Entity Type:Individual
Prefix:
First Name:LEA ANGELICA
Middle Name:BOLLOZOS
Last Name:TANSECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 ADAMSTOWN COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21710-8922
Mailing Address - Country:US
Mailing Address - Phone:443-519-9810
Mailing Address - Fax:
Practice Address - Street 1:1045 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7201
Practice Address - Country:US
Practice Address - Phone:301-739-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist