Provider Demographics
NPI:1003140047
Name:TRANTINA, CARISSA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:MARIE
Last Name:TRANTINA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 AMITY RD APT J6
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8657
Mailing Address - Country:US
Mailing Address - Phone:501-463-4905
Mailing Address - Fax:
Practice Address - Street 1:136 OAKBROOK ST
Practice Address - Street 2:
Practice Address - City:PEARCY
Practice Address - State:AR
Practice Address - Zip Code:71964-9464
Practice Address - Country:US
Practice Address - Phone:501-767-9351
Practice Address - Fax:501-767-7909
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#P8222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist