Provider Demographics
NPI:1306330436
Name:WAYNE-HOUTZ, TANYA MARIE
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:WAYNE-HOUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:501 FARBER RD APT 105
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5959
Mailing Address - Country:US
Mailing Address - Phone:646-737-2402
Mailing Address - Fax:
Practice Address - Street 1:118 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3491
Practice Address - Country:US
Practice Address - Phone:718-552-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist