Provider Demographics
NPI:1609117571
Name:ELMORE, TANISHA PATRICE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:PATRICE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2108
Mailing Address - Country:US
Mailing Address - Phone:803-378-1493
Mailing Address - Fax:
Practice Address - Street 1:460 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2108
Practice Address - Country:US
Practice Address - Phone:803-378-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist