Provider Demographics
NPI:1902878028
Name:TANNER, REBECCA NUNN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NUNN
Last Name:TANNER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 13TH ST SE
Mailing Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4165
Mailing Address - Country:US
Mailing Address - Phone:828-267-1688
Mailing Address - Fax:828-267-1690
Practice Address - Street 1:1087 13TH ST SE
Practice Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4165
Practice Address - Country:US
Practice Address - Phone:828-267-1688
Practice Address - Fax:828-267-1690
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9072860OtherPHCS
NC7481494Medicaid
NC81494OtherBCBS
11313164OtherCAQH
NC23315OtherMEDCOST