Provider Demographics
NPI:1609402171
Name:TANGVALD, CLAIRE RAKEL (BA, CF- SLP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:RAKEL
Last Name:TANGVALD
Suffix:
Gender:F
Credentials:BA, CF- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BENEVITA PL APT 103
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3172
Mailing Address - Country:US
Mailing Address - Phone:360-591-2766
Mailing Address - Fax:
Practice Address - Street 1:4510 INTELCO LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6004
Practice Address - Country:US
Practice Address - Phone:360-786-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program