Provider Demographics
NPI:1336581719
Name:KINSLAND-TATHAM, RANDI LAUREN (MS CCCS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LAUREN
Last Name:KINSLAND-TATHAM
Suffix:
Gender:F
Credentials:MS CCCS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NESBITT ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6623
Mailing Address - Country:US
Mailing Address - Phone:828-550-5838
Mailing Address - Fax:
Practice Address - Street 1:76 LEROY GEORGE DRIVE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-452-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist