Healthcare Provider Details

I. General information

NPI: 1043710163
Provider Name (Legal Business Name): TANYA HUTSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 PARK POINTE WAY
HUNTINGTON WV
25701-4052
US

IV. Provider business mailing address

178 PARK POINTE WAY
HUNTINGTON WV
25701-4052
US

V. Phone/Fax

Practice location:
  • Phone: 540-520-9484
  • Fax:
Mailing address:
  • Phone: 540-520-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number252192
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002853
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2019
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: