Provider Demographics
NPI:1023899499
Name:TANNER, VIRGINIA LILL
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LILL
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:LILL
Other - Last Name:NETTERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8818 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-5706
Mailing Address - Country:US
Mailing Address - Phone:601-597-8000
Mailing Address - Fax:
Practice Address - Street 1:8818 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-5706
Practice Address - Country:US
Practice Address - Phone:601-597-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist