Provider Demographics
NPI:1336562834
Name:HANCOCK, TABETHA ANN
Entity Type:Individual
Prefix:MRS
First Name:TABETHA
Middle Name:ANN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TABETHA
Other - Middle Name:ANN
Other - Last Name:DREWNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1250 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02715-1231
Mailing Address - Country:US
Mailing Address - Phone:508-669-4245
Mailing Address - Fax:
Practice Address - Street 1:1250 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02715-1231
Practice Address - Country:US
Practice Address - Phone:508-669-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist