Provider Demographics
NPI:1346547296
Name:KOGNOVITSKAIA, TATIANA I (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:KOGNOVITSKAIA
Suffix:I
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-0093
Mailing Address - Country:US
Mailing Address - Phone:541-475-7702
Mailing Address - Fax:
Practice Address - Street 1:700 SE LAREDO DR
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9299
Practice Address - Country:US
Practice Address - Phone:541-475-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist