Provider Demographics
NPI:1891046850
Name:CROSS, TATIANA MARIA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:MARIA
Last Name:CROSS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:TATIANA
Other - Middle Name:MARIA
Other - Last Name:SEKELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2136 BRICK SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9191
Mailing Address - Country:US
Mailing Address - Phone:585-721-1654
Mailing Address - Fax:
Practice Address - Street 1:2136 BRICK SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9191
Practice Address - Country:US
Practice Address - Phone:585-721-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023447-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist