Provider Demographics
NPI:1811358179
Name:ZELWALK, TANYA L (MA/LBS)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:ZELWALK
Suffix:
Gender:F
Credentials:MA/LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 FREEDOM WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9282
Mailing Address - Country:US
Mailing Address - Phone:717-600-0900
Mailing Address - Fax:717-600-0910
Practice Address - Street 1:1701 TAXVILLE RD
Practice Address - Street 2:APT 21F
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4467
Practice Address - Country:US
Practice Address - Phone:717-792-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst