Provider Demographics
NPI:1386862399
Name:BASHLINE, TRAVIS AARON (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:AARON
Last Name:BASHLINE
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SLATER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:PA
Mailing Address - Zip Code:16049
Mailing Address - Country:US
Mailing Address - Phone:724-791-1163
Mailing Address - Fax:
Practice Address - Street 1:110 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-887-5591
Practice Address - Fax:814-887-5666
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006281L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018800000007Medicaid