Provider Demographics
NPI:1588045801
Name:FLETCHER, TANYA LYN (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4773
Mailing Address - Country:US
Mailing Address - Phone:801-562-3189
Mailing Address - Fax:
Practice Address - Street 1:3584 W 9000 S STE 102
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4773
Practice Address - Country:US
Practice Address - Phone:801-562-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284882-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist