Provider Demographics
NPI:1134859432
Name:MCCARTHY, TAMMY D (SLP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:D
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6425
Mailing Address - Country:US
Mailing Address - Phone:707-599-1609
Mailing Address - Fax:
Practice Address - Street 1:901 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-9550
Practice Address - Country:US
Practice Address - Phone:707-599-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist