| NPI | 1487808010 |
|---|---|
| Former Name | JOHANNA MARIE TANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202003003) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MD 04396) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2009-09-13 |