Provider Demographics
NPI:1710149364
Name:CHOVANETZ, TANJA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:
Last Name:CHOVANETZ
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 1:2002 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2409
Mailing Address - Country:US
Mailing Address - Phone:210-394-9636
Mailing Address - Fax:
Practice Address - Street 1:708 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945
Practice Address - Country:US
Practice Address - Phone:979-968-4102
Practice Address - Fax:979-968-2337
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist