Provider Demographics
NPI:1881085165
Name:VAARA-SUYDAM, TASHA LINNEA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:LINNEA
Last Name:VAARA-SUYDAM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2697
Mailing Address - Country:US
Mailing Address - Phone:810-519-8227
Mailing Address - Fax:810-519-8056
Practice Address - Street 1:113 RIVER STREET
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2697
Practice Address - Country:US
Practice Address - Phone:810-519-8227
Practice Address - Fax:810-519-8056
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01092446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist