Healthcare Provider Details

I. General information

NPI: 1881084895
Provider Name (Legal Business Name): TANYA NICHOLE TETZNER SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 E 42ND ST S STE 220
INDEPENDENCE MO
64055-4700
US

IV. Provider business mailing address

14500 E 42ND ST S STE 220
INDEPENDENCE MO
64055-4700
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-7800
  • Fax: 816-478-7839
Mailing address:
  • Phone: 816-478-7800
  • Fax: 816-478-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2015033421
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: