Provider Demographics
NPI:1679335392
Name:VAN VOORST, TANYA (AUD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:VAN VOORST
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W CHERRY ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0187
Mailing Address - Country:US
Mailing Address - Phone:319-249-6925
Mailing Address - Fax:319-205-0625
Practice Address - Street 1:585 W CHERRY ST STE A
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9797
Practice Address - Country:US
Practice Address - Phone:319-249-6925
Practice Address - Fax:319-205-0625
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00557231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist