Provider Demographics
NPI:1558540377
Name:WOODS, TANA KAY (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:KAY
Last Name:WOODS
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 1:66 COUNTY ROAD 3235
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-9540
Mailing Address - Country:US
Mailing Address - Phone:505-334-1682
Mailing Address - Fax:505-334-1682
Practice Address - Street 1:66 COUNTY ROAD 3235
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9540
Practice Address - Country:US
Practice Address - Phone:505-334-1682
Practice Address - Fax:505-334-1682
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist