Provider Demographics
NPI:1871002576
Name:TANAKA, TRISHA LYNN (MS, SLP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:TANAKA
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 W 184TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4811
Mailing Address - Country:US
Mailing Address - Phone:707-980-1072
Mailing Address - Fax:
Practice Address - Street 1:2850 ARTESIA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3412
Practice Address - Country:US
Practice Address - Phone:424-275-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist