Provider Demographics
NPI:1598819245
Name:DRURY, TAMMY GWEN (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:GWEN
Last Name:DRURY
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 COUNTY ROAD 313
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8446
Mailing Address - Country:US
Mailing Address - Phone:573-243-9004
Mailing Address - Fax:
Practice Address - Street 1:6276 COUNTY ROAD 313
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-8446
Practice Address - Country:US
Practice Address - Phone:573-243-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist