Provider Demographics
NPI:1508002791
Name:FRIEND, TANYA R (SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:R
Last Name:FRIEND
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 1:7103 4TH ST NW STE F
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6675
Mailing Address - Country:US
Mailing Address - Phone:505-821-1638
Mailing Address - Fax:505-821-5107
Practice Address - Street 1:7103 4TH ST NW STE F
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6675
Practice Address - Country:US
Practice Address - Phone:505-821-1638
Practice Address - Fax:505-821-5107
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist