Provider Demographics
NPI:1659332559
Name:LUBSEN, TINA L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:LUBSEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:1600 HIGHWAY 78 E # G
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4083
Practice Address - Country:US
Practice Address - Phone:205-384-4895
Practice Address - Fax:285-384-3227
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X, 237700000X
FLAY 1516231H00000X
MO2008008300231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist