Provider Demographics
NPI:1124230503
Name:CLAIR, TRINA MARIE (MS, CCC-SLP-L)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:MARIE
Last Name:CLAIR
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 1:202 W BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-4555
Mailing Address - Country:US
Mailing Address - Phone:217-488-2165
Mailing Address - Fax:
Practice Address - Street 1:202 W BIRCH ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:IL
Practice Address - Zip Code:62670-4555
Practice Address - Country:US
Practice Address - Phone:217-488-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist