Provider Demographics
NPI:1376731521
Name:CUNNINGHAM, TANYA (SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CUNNINGHAM
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 1:1730 UNIVERSITY BLVD SE
Mailing Address - Street 2:CESS TRANSITION SVCS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3937
Mailing Address - Country:US
Mailing Address - Phone:505-872-6800
Mailing Address - Fax:
Practice Address - Street 1:1730 UNIVERSITY BLVD SE
Practice Address - Street 2:CESS TRANSITION SVCS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3937
Practice Address - Country:US
Practice Address - Phone:505-872-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC 4162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNED YETMedicaid