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NPI Code Detail

MEDICARE: TAMMY IRWIN MS, CCC-SLP

MEDICARE: TAMMY IRWIN MS, 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
1235Z00000XSpeech-Language Pathologist5129NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2135HTOTHERNCNC BCBS

General Provider Information

NPI Number : 1255336293
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY IRWIN MS, CCC-SLP
Provider Business Mailing Address
First Line : 185 CHARLOIS BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-1521
Country : US
Telephone Number : 336-725-0222
Fax Number : 336-725-0454
Provider Business Practice Location Address
First Line : 185 CHARLOIS BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-1521
Country : US
Telephone Number : 336-725-0222
Fax Number : 336-725-0454
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 09/27/2007

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