Provider Demographics
NPI:1366018145
Name:DORTIN, TANYA (SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DORTIN
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 1:1244 N FLINT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-5239
Mailing Address - Country:US
Mailing Address - Phone:704-740-0676
Mailing Address - Fax:704-240-3500
Practice Address - Street 1:1244 N FLINT ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-5239
Practice Address - Country:US
Practice Address - Phone:704-740-0676
Practice Address - Fax:704-240-3500
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist