Provider Demographics
NPI:1568660751
Name:HARDISON, TAMMY MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:HARDISON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:BASILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 GOODWIN LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1431
Mailing Address - Country:US
Mailing Address - Phone:631-509-0046
Mailing Address - Fax:
Practice Address - Street 1:14 GOODWIN LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1431
Practice Address - Country:US
Practice Address - Phone:631-509-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014081-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist