Individual
GRANT TATGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12350 INDUSTRY WAY, SUITE 202, ANCHORAGE, AK 99515-4300
(907) 301-4588
Mailing address
12350 INDUSTRY WAY, SUITE 202, ANCHORAGE, AK 99515-4300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
102224
AK
Other
Enumeration date
10/25/2015
Last updated
10/25/2015
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