Provider Demographics
NPI:1144894148
Name:HALEY, TANYA C (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:C
Last Name:HALEY
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 S FENTON LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4078
Mailing Address - Country:US
Mailing Address - Phone:571-499-3981
Mailing Address - Fax:
Practice Address - Street 1:2514 S FENTON LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4078
Practice Address - Country:US
Practice Address - Phone:571-499-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist