Provider Demographics
NPI:1124361035
Name:HASKINS, TINA (SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HASKINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3302
Mailing Address - Country:US
Mailing Address - Phone:503-390-8520
Mailing Address - Fax:
Practice Address - Street 1:3099 RIVER RD S STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-9754
Practice Address - Country:US
Practice Address - Phone:503-581-1567
Practice Address - Fax:503-485-2590
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist