Provider Demographics
NPI:1992422422
Name:ROMERO, TANISHANN (SLPA)
Entity type:Individual
Prefix:
First Name:TANISHANN
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29697 N DESERT WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3917
Mailing Address - Country:US
Mailing Address - Phone:480-987-5360
Mailing Address - Fax:
Practice Address - Street 1:29697 N DESERT WILLOW BLVD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-3917
Practice Address - Country:US
Practice Address - Phone:480-987-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA128292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant