Provider Demographics
NPI:1871621169
Name:LAND, TANIA LORRIAINE BUMGARNER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:LORRIAINE BUMGARNER
Last Name:LAND
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:4108 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3910
Mailing Address - Country:US
Mailing Address - Phone:336-834-0554
Mailing Address - Fax:336-852-9342
Practice Address - Street 1:4108 CASCADE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3910
Practice Address - Country:US
Practice Address - Phone:336-834-0554
Practice Address - Fax:336-852-9342
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411443Medicaid