Provider Demographics
NPI:1134761596
Name:TAGUE, TAMISHA SHAWNDIS (SPA 2013)
Entity type:Individual
Prefix:MRS
First Name:TAMISHA
Middle Name:SHAWNDIS
Last Name:TAGUE
Suffix:
Gender:F
Credentials:SPA 2013
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 ARTESIA BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3412
Mailing Address - Country:US
Mailing Address - Phone:424-275-9968
Mailing Address - Fax:
Practice Address - Street 1:2850 ARTESIA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3412
Practice Address - Country:US
Practice Address - Phone:424-275-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA20132355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant