MEDICARE: JULIA TANS M.S., CCC-SLP

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	TSLP13196	AZ
2	235Z00000X	Speech-Language Pathologist	SLP13196	AZ
3	235Z00000X	Speech-Language Pathologist	7101008784	MI

General Provider Information

NPI Number	:	1104591353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA TANS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5051 36TH AVE
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1611
Country	:	US
Telephone Number	:	616-322-3985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 E APPLE AVE STE H
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-4281
Country	:	US
Telephone Number	:	231-333-9148
Fax Number	:

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

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	04/29/2024

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