Provider Demographics
NPI:1578905535
Name:MCDOWELL, TIANA M (MA)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:M
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3445
Mailing Address - Country:US
Mailing Address - Phone:707-319-4742
Mailing Address - Fax:
Practice Address - Street 1:501 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3445
Practice Address - Country:US
Practice Address - Phone:707-319-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8310235Z00000X
CA21803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist