Provider Demographics
NPI:1003391228
Name:SANTOS, TANYA (SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3131
Mailing Address - Country:US
Mailing Address - Phone:469-231-4397
Mailing Address - Fax:
Practice Address - Street 1:14160 DALLAS PKWY STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4356
Practice Address - Country:US
Practice Address - Phone:972-385-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist