Provider Demographics
NPI:1801022280
Name:HANLEY, TANA (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:HANLEY
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 1:201 SPEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LYON MOUNTAIN
Mailing Address - State:NY
Mailing Address - Zip Code:12955-3113
Mailing Address - Country:US
Mailing Address - Phone:518-651-5260
Mailing Address - Fax:
Practice Address - Street 1:355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1827
Practice Address - Country:US
Practice Address - Phone:518-651-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009693-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist