Provider Demographics
NPI:1639324767
Name:WOOLCOCK, TANIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:WOOLCOCK
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 1:153 6TH AVE
Mailing Address - Street 2:APT. 12 B
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1632
Mailing Address - Country:US
Mailing Address - Phone:845-348-0070
Mailing Address - Fax:
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2319
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:914-328-2973
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist