Provider Demographics
NPI:1891856704
Name:DENKINGER, TIA FORTES (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:FORTES
Last Name:DENKINGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:FORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:928 RAVENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6421
Mailing Address - Country:US
Mailing Address - Phone:678-410-9632
Mailing Address - Fax:
Practice Address - Street 1:928 RAVENWOOD WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-6421
Practice Address - Country:US
Practice Address - Phone:678-410-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA585301787AMedicaid