Provider Demographics
NPI:1942483573
Name:POWELL, TANDIE J (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TANDIE
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MS
Other - First Name:TANDIE
Other - Middle Name:J
Other - Last Name:FOSDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:1005 E 23RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-0800
Mailing Address - Country:US
Mailing Address - Phone:812-236-8851
Mailing Address - Fax:
Practice Address - Street 1:1005 E 23RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-0800
Practice Address - Country:US
Practice Address - Phone:812-236-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004195A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist