Provider Demographics
NPI:1417197120
Name:MATTHEWS, TANYA SENISE (SLP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:SENISE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTERS
Mailing Address - Street 1:2801 MAIN ST
Mailing Address - Street 2:APARTMENT 216
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5027
Mailing Address - Country:US
Mailing Address - Phone:714-724-6744
Mailing Address - Fax:
Practice Address - Street 1:7217 MARGARET CHAPEL RD
Practice Address - Street 2:
Practice Address - City:STALEY
Practice Address - State:NC
Practice Address - Zip Code:27355-8239
Practice Address - Country:US
Practice Address - Phone:714-724-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist