Provider Demographics
NPI:1669836573
Name:TANYA MANRIQUEZ LUJAN M.S., CCC-SLP, PLLC
Entity Type:Organization
Organization Name:TANYA MANRIQUEZ LUJAN M.S., CCC-SLP, PLLC
Other - Org Name:WEST TEXAS SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MANRIQUEZ
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, COM
Authorized Official - Phone:432-661-5405
Mailing Address - Street 1:3311 MILANO DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8979
Mailing Address - Country:US
Mailing Address - Phone:432-661-5405
Mailing Address - Fax:
Practice Address - Street 1:4010 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2233
Practice Address - Country:US
Practice Address - Phone:432-614-0268
Practice Address - Fax:888-972-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty