Provider Demographics
NPI:1497454730
Name:LATCHAW, TYANA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TYANA
Middle Name:
Last Name:LATCHAW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 RED PINE CIR
Mailing Address - Street 2:
Mailing Address - City:TIONESTA
Mailing Address - State:PA
Mailing Address - Zip Code:16353-4121
Mailing Address - Country:US
Mailing Address - Phone:814-319-6721
Mailing Address - Fax:
Practice Address - Street 1:999 HEIDRICK ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1745
Practice Address - Country:US
Practice Address - Phone:814-226-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL15749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist