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General NPI Number Information
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NPI Number | 1285106476
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Entity Type | Individual
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Provider Name | TATYANA VINNICHUK
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Gender | Female
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 1600 EUREKA RD
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City | ROSEVILLE
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State | CA
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Zip | 95661-3027
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Country | US
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Telephone | 916-878-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 1288 GRAND JUNCTION WAY
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City | ROSEVILLE
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State | CA
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Zip | 95747-9285
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Country | US
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Telephone | 916-878-6364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 23507
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License Number State | CA
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