Provider Demographics
NPI:1104688779
Name:LANDRUM, TAJIA
Entity type:Individual
Prefix:
First Name:TAJIA
Middle Name:
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20290 PARK LAKE VIEW DR APT 4201
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1987
Mailing Address - Country:US
Mailing Address - Phone:864-347-6988
Mailing Address - Fax:
Practice Address - Street 1:20290 PARK LAKE VIEW DR APT 4201
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1987
Practice Address - Country:US
Practice Address - Phone:864-347-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX433442355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant