MEDICARE: DANA MARIE TAPPEN

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	SP15125	CA

General Provider Information

NPI Number	:	1205068863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA MARIE TAPPEN

Provider Business Mailing Address
First Line	:	625 FAIR OAKS AVE STE 200
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-2694
Country	:	US
Telephone Number	:	323-341-5580
Fax Number	:	323-340-8298

Provider Business Practice Location Address
First Line	:	4295 GESNER ST STE 2C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6690
Country	:	US
Telephone Number	:	619-275-4525
Fax Number	:	619-275-4526

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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Directions to “ DANA MARIE TAPPEN ” Practice Location

Language	Start Address	Practice Location

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