Individual
MRS. TANYA JEAN DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
43 RANDO LN, WALTHAM, MA 02451-7541
(978) 460-3718
Mailing address
43 RANDO LN, WALTHAM, MA 02451-7541
(978) 460-3718
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-9787-SL
MA
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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