MEDICARE: TALLY PAANANEN

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	7101007979	MI

General Provider Information

NPI Number	:	1043052111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALLY PAANANEN

Provider Business Mailing Address
First Line	:	841 W WASHINGTON ST
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 COUNTY ROAD HQ
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-8855
Country	:	US
Telephone Number	:	906-225-5900
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	03/18/2026

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Directions to “ TALLY PAANANEN ” Practice Location

Language	Start Address	Practice Location

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