Provider Demographics
NPI:1003430786
Name:HENNIX, TANYA MARIE
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:HENNIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 21ST AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-0817
Mailing Address - Country:US
Mailing Address - Phone:701-850-9683
Mailing Address - Fax:701-839-8990
Practice Address - Street 1:1425 21ST AVE NW STE A
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0817
Practice Address - Country:US
Practice Address - Phone:701-850-9683
Practice Address - Fax:701-839-8990
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker