Provider Demographics
NPI:1083773485
Name:HAASE, TANYA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:HAASE
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 1:1810 4TH ST SW STE 103A
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-4333
Mailing Address - Country:US
Mailing Address - Phone:319-352-5726
Mailing Address - Fax:
Practice Address - Street 1:1810 4TH ST SW STE 103A
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-4333
Practice Address - Country:US
Practice Address - Phone:319-352-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist