Provider Demographics
NPI:1932520483
Name:TABB, PATRICIA ANN (BSW APRIL2014)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:TABB
Suffix:
Gender:F
Credentials:BSW APRIL2014
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3147
Mailing Address - Country:US
Mailing Address - Phone:734-219-7079
Mailing Address - Fax:
Practice Address - Street 1:1361 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3147
Practice Address - Country:US
Practice Address - Phone:734-219-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-01
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIT100676067323390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program