Provider Demographics
NPI:1205068863
Name:TAPPEN, DANA MARIE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:TAPPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:TAPPEN RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2694
Mailing Address - Country:US
Mailing Address - Phone:323-341-5580
Mailing Address - Fax:323-340-8298
Practice Address - Street 1:4295 GESNER ST STE 2C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6690
Practice Address - Country:US
Practice Address - Phone:619-275-4525
Practice Address - Fax:619-275-4526
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist