Provider Demographics
NPI:1487870820
Name:CALLINS, TANDRIA MILAGNO (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:TANDRIA
Middle Name:MILAGNO
Last Name:CALLINS
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:6571 EAGLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5684
Mailing Address - Country:US
Mailing Address - Phone:863-868-3843
Mailing Address - Fax:863-868-7647
Practice Address - Street 1:4240 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3113
Practice Address - Country:US
Practice Address - Phone:863-607-5946
Practice Address - Fax:868-644-4202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA7606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist