Provider Demographics
NPI:1821395120
Name:QUESINBERRY, TAZMERAI (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAZMERAI
Middle Name:
Last Name:QUESINBERRY
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 1:901 WOODLANDS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2483
Mailing Address - Country:US
Mailing Address - Phone:412-609-1534
Mailing Address - Fax:
Practice Address - Street 1:901 WOODLANDS DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2483
Practice Address - Country:US
Practice Address - Phone:412-609-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist