Provider Demographics
NPI:1114940616
Name:SAUNDERS, TINA (MCCC/SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:MCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 LAKE DEESON PT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9213
Mailing Address - Country:US
Mailing Address - Phone:813-477-7624
Mailing Address - Fax:863-802-1802
Practice Address - Street 1:1311 LAKE DEESON PT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-9213
Practice Address - Country:US
Practice Address - Phone:813-477-7624
Practice Address - Fax:863-802-1802
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889864200Medicaid
FL812207500Medicaid