Provider Demographics
NPI:1669794533
Name:KLISH, TANYA DAWN (SLP, CCC)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:DAWN
Last Name:KLISH
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11874 W 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5130
Mailing Address - Country:US
Mailing Address - Phone:612-747-8461
Mailing Address - Fax:
Practice Address - Street 1:1500 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2601
Practice Address - Country:US
Practice Address - Phone:720-972-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO232152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist