Provider Demographics
NPI:1790269199
Name:SPAGNUOLO, TIA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:M
Last Name:SPAGNUOLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-2114
Mailing Address - Country:US
Mailing Address - Phone:570-814-3893
Mailing Address - Fax:
Practice Address - Street 1:100 N WILKES BARRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5255
Practice Address - Country:US
Practice Address - Phone:570-406-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist