Healthcare Provider Details

I. General information

NPI: 1861818767
Provider Name (Legal Business Name): TANYA RAINEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 ISLAND CT
CARROLLTON TX
75007-6306
US

IV. Provider business mailing address

3812 ISLAND CT
CARROLLTON TX
75007-6306
US

V. Phone/Fax

Practice location:
  • Phone: 972-552-0950
  • Fax:
Mailing address:
  • Phone: 972-552-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number108316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: