Provider Demographics
NPI:1013429471
Name:FREEMAN, TAMARA LYNN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 GEORGETOWN LOOP
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2773
Mailing Address - Country:US
Mailing Address - Phone:757-329-0602
Mailing Address - Fax:
Practice Address - Street 1:389 GEORGETOWN LOOP
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2773
Practice Address - Country:US
Practice Address - Phone:757-329-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12004622OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION