Provider Demographics
NPI:1609095371
Name:SAHAGON, TAMMY L
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:SAHAGON
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 1:2227 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-771-0453
Mailing Address - Fax:
Practice Address - Street 1:2227 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-985-9944
Practice Address - Fax:501-985-6590
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C652OtherMEDICARE ID
AR5C724OtherIDTF