Provider Demographics
NPI:1437589629
Name:WITT, TANIA LYN (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:LYN
Last Name:WITT
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29531 SD HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523-5146
Mailing Address - Country:US
Mailing Address - Phone:605-775-2013
Mailing Address - Fax:
Practice Address - Street 1:29531 SD HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-5146
Practice Address - Country:US
Practice Address - Phone:605-775-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD162-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist