Provider Demographics
NPI:1093938474
Name:DOGGAN, TINEKA N (DEVLOPMENTAL THERAPY)
Entity Type:Individual
Prefix:
First Name:TINEKA
Middle Name:N
Last Name:DOGGAN
Suffix:
Gender:F
Credentials:DEVLOPMENTAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2114
Mailing Address - Country:US
Mailing Address - Phone:618-242-9056
Mailing Address - Fax:618-242-9056
Practice Address - Street 1:4304 LILAC LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2114
Practice Address - Country:US
Practice Address - Phone:618-242-9056
Practice Address - Fax:618-242-9056
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist