MEDICARE: JAMIE L TANENBAUM 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	5878	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1330J	OTHER	NC	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467657288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE L TANENBAUM M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	205 MEADOWBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1307
Country	:	US
Telephone Number	:	704-649-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 MEADOWBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1307
Country	:	US
Telephone Number	:	704-649-5311
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	12/06/2016

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Directions to “ JAMIE L TANENBAUM M.S., CCC-SLP” Practice Location

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