Provider Demographics
NPI:1558393454
Name:WOZNIAK, TANYA Y (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:Y
Last Name:WOZNIAK
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 1:4829 CROWNVISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0870
Mailing Address - Country:US
Mailing Address - Phone:704-299-7585
Mailing Address - Fax:704-274-5602
Practice Address - Street 1:4829 CROWNVISTA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0870
Practice Address - Country:US
Practice Address - Phone:704-299-7585
Practice Address - Fax:704-274-5602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412126Medicaid
NC140CVOtherBCBS OUT-OF-NETWORK