Provider Demographics
NPI:1306909718
Name:CURTIS, TANYA ROSE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ROSE
Last Name:CURTIS
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 1:203 S MAIN ST
Mailing Address - Street 2:PO BOX 585
Mailing Address - City:SHERIDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59749-0585
Mailing Address - Country:US
Mailing Address - Phone:877-801-0024
Mailing Address - Fax:877-801-0024
Practice Address - Street 1:203 S MAIN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MT
Practice Address - Zip Code:59749-0585
Practice Address - Country:US
Practice Address - Phone:877-801-0024
Practice Address - Fax:877-801-0024
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11473235Z00000X
MT981235Z00000X
OH10750235Z00000X
WYSP-702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182874OtherMCD
ID805990800Medicaid
MT0690778OtherMCD
MT0532117Medicaid
MT5604271Medicaid
WA9050733OtherMCD
311040OtherBCBS
ND54834OtherMCD
ID805990800Medicaid