Provider Demographics
NPI:1710145099
Name:NIELSEN, TANYA MCCREA (MS CCCA)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MCCREA
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:MCCREA
Other - Last Name:GROPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCA
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-407-4200
Mailing Address - Fax:816-407-2362
Practice Address - Street 1:2521 GLENN HENDREN DR STE 104
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-0408
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE051231H00000X
MO2019044094231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019044094OtherMISSOURI LICENSE
NE10025369400Medicaid