Provider Demographics
NPI:1588789663
Name:ADAMS, TANIA SHERVON (SLP-CCC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:SHERVON
Last Name:ADAMS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:SHERVON
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 WINDING TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2289
Mailing Address - Country:US
Mailing Address - Phone:804-955-5311
Mailing Address - Fax:
Practice Address - Street 1:4550 SHENANDOAH AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-4749
Practice Address - Country:US
Practice Address - Phone:540-982-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist