Provider Demographics
NPI:1245606557
Name:ROAN, TRISTIN LEIGH (MS, CCC,SLP)
Entity Type:Individual
Prefix:
First Name:TRISTIN
Middle Name:LEIGH
Last Name:ROAN
Suffix:
Gender:F
Credentials:MS, CCC,SLP
Other - Prefix:
Other - First Name:TRISTIN
Other - Middle Name:LEIGH
Other - Last Name:ROAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KIRKPATRICK
Mailing Address - Street 1:2400 N GRIMES ST STE B26
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2124
Mailing Address - Country:US
Mailing Address - Phone:575-437-2001
Mailing Address - Fax:
Practice Address - Street 1:2400 N GRIMES ST STE B26
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:575-437-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist