Provider Demographics
NPI:1902093354
Name:FOUTZ, TANDI RAQUELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANDI
Middle Name:RAQUELLE
Last Name:FOUTZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 HUTTON AVE
Mailing Address - Street 2:ANIMAS ELEMENTARY SCHOOL
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-7614
Mailing Address - Country:US
Mailing Address - Phone:505-599-8601
Mailing Address - Fax:
Practice Address - Street 1:1612 HUTTON AVE
Practice Address - Street 2:ANIMAS ELEMENTARY SCHOOL
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-7614
Practice Address - Country:US
Practice Address - Phone:505-599-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4163235Z00000X
NM322345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist