Provider Demographics
NPI:1003207564
Name:VINING, AZMINA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AZMINA
Middle Name:
Last Name:VINING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:AZMINA
Other - Middle Name:
Other - Last Name:BACHELANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:6693 TIMBER RIDGE LANE CT
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-6100
Mailing Address - Country:US
Mailing Address - Phone:651-353-0634
Mailing Address - Fax:
Practice Address - Street 1:6693 TIMBER RIDGE LANE CT
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-6100
Practice Address - Country:US
Practice Address - Phone:651-353-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3993-154235Z00000X
MN9318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist