Provider Demographics
NPI:1386772192
Name:POPE, TANIA V (MA-CCC-SLP)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:V
Last Name:POPE
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S EDGELAWN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-5205
Mailing Address - Country:US
Mailing Address - Phone:630-264-8083
Mailing Address - Fax:630-566-5797
Practice Address - Street 1:735 S EDGELAWN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5205
Practice Address - Country:US
Practice Address - Phone:630-264-8083
Practice Address - Fax:630-566-5797
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist