Provider Demographics
NPI:1003939042
Name:BLAND, TRINA LONDRA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:LONDRA
Last Name:BLAND
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8876 SWEET FLAG LOOP W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7206
Mailing Address - Country:US
Mailing Address - Phone:662-404-3580
Mailing Address - Fax:
Practice Address - Street 1:1250 FARROW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7116
Practice Address - Country:US
Practice Address - Phone:901-345-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4460338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist