Provider Demographics
NPI:1932932449
Name:FETTINGER, TANNER
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:FETTINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CEDAR ST NW APT B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1924
Mailing Address - Country:US
Mailing Address - Phone:973-919-0213
Mailing Address - Fax:
Practice Address - Street 1:4530 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4202
Practice Address - Country:US
Practice Address - Phone:202-299-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist