Provider Demographics
NPI:1790656502
Name:RUSH, TATUM J
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:J
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:J
Other - Last Name:COOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5266
Mailing Address - Country:US
Mailing Address - Phone:308-529-7962
Mailing Address - Fax:
Practice Address - Street 1:1322 AVENUE I
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1815
Practice Address - Country:US
Practice Address - Phone:308-537-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist