Provider Demographics
NPI:1548218852
Name:TRENKA, TANIS M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANIS
Middle Name:M
Last Name:TRENKA
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 1:11 CANDLELIGHT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6076
Mailing Address - Country:US
Mailing Address - Phone:406-570-9465
Mailing Address - Fax:
Practice Address - Street 1:1122 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3887
Practice Address - Country:US
Practice Address - Phone:406-570-9465
Practice Address - Fax:406-582-4148
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0535119Medicaid
MT662480OtherBCBS PRIVATE
MT1548218852OtherALLEGIANCE BENEFIT PLAN MANAGEMENT, INC.
MT0534922Medicaid