Provider Demographics
NPI:1659516722
Name:HAVEL, TASHA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:MARIE
Last Name:HAVEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 SHORE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4294
Mailing Address - Country:US
Mailing Address - Phone:715-732-5111
Mailing Address - Fax:715-732-0628
Practice Address - Street 1:3117 SHORE DR STE 101
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4294
Practice Address - Country:US
Practice Address - Phone:715-732-5111
Practice Address - Fax:715-732-0628
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3129-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3129-154OtherWISCONSIN STATE LICENSE