Provider Demographics
NPI:1144724972
Name:DEGEORGE, TAMI (SLP)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:SCONZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1545 W US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1562
Mailing Address - Country:US
Mailing Address - Phone:219-836-5381
Mailing Address - Fax:219-836-4466
Practice Address - Street 1:1545 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1562
Practice Address - Country:US
Practice Address - Phone:219-836-5381
Practice Address - Fax:219-836-4466
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004015A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist