Provider Demographics
NPI:1376766832
Name:TANKSLEY, LASHAWN (MSM, MED CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LASHAWN
Middle Name:
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:MSM, MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 TYLER WOODS CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-6303
Mailing Address - Country:US
Mailing Address - Phone:706-627-6830
Mailing Address - Fax:706-650-5773
Practice Address - Street 1:351 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-9686
Practice Address - Country:US
Practice Address - Phone:706-554-4435
Practice Address - Fax:706-437-9702
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist