Provider Demographics
NPI:1093831703
Name:GARMON, TINA MARIE (MS CCC SLP L)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:GARMON
Suffix:
Gender:F
Credentials:MS CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-8671
Mailing Address - Country:US
Mailing Address - Phone:630-670-0901
Mailing Address - Fax:630-654-4619
Practice Address - Street 1:607 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-8671
Practice Address - Country:US
Practice Address - Phone:630-670-0901
Practice Address - Fax:630-654-4619
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist