Provider Demographics
NPI:1912330341
Name:TATE, BRANDY L (SLP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:TATE
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 1:3005 E MAIN
Mailing Address - Street 2:APT H5
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3108
Mailing Address - Country:US
Mailing Address - Phone:276-620-6566
Mailing Address - Fax:
Practice Address - Street 1:3005 E MAIN
Practice Address - Street 2:APT H5
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3108
Practice Address - Country:US
Practice Address - Phone:276-620-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist