=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326565391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA VICTORIA TAPIA M. S. CCC-SLP, M.ED.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2017
-----------------------------------------------------
Last Update Date | 06/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43865 W KRAMER LN
-----------------------------------------------------
City | MARICOPA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85138-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-596-8147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43865 W KRAMER LN
-----------------------------------------------------
City | MARICOPA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85138-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-596-8147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP10403
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------