Provider Demographics
NPI:1336458678
Name:LOCKWOOD, TANYA (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712-9530
Mailing Address - Country:US
Mailing Address - Phone:716-567-4075
Mailing Address - Fax:
Practice Address - Street 1:3980 DUTCH HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:BEMUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14712
Practice Address - Country:US
Practice Address - Phone:716-386-4932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist