MEDICARE: MRS. VIRGINIA LILL TANNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1023899499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA LILL TANNER

Provider Business Mailing Address
First Line	:	8818 US HIGHWAY 61
Second Line	:
City	:	SAINT FRANCISVILLE
State	:	LA
Zip	:	70775-5706
Country	:	US
Telephone Number	:	601-597-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8818 US HIGHWAY 61
Second Line	:
City	:	SAINT FRANCISVILLE
State	:	LA
Zip	:	70775-5706
Country	:	US
Telephone Number	:	601-597-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	10/11/2023

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Directions to “ MRS. VIRGINIA LILL TANNER ” Practice Location

Language	Start Address	Practice Location

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