Provider Demographics
NPI:1780869461
Name:BEARD, TANYA (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BELLE CHASSE DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3162
Mailing Address - Country:US
Mailing Address - Phone:601-668-8772
Mailing Address - Fax:
Practice Address - Street 1:110 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2013
Practice Address - Country:US
Practice Address - Phone:318-757-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8306235Z00000X
MSS2075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120389Medicaid