Provider Demographics
NPI:1801370796
Name:HOWELL, TRINA BERNADEAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:BERNADEAN
Last Name:HOWELL
Suffix:
Gender:F
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 1:1419 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5940
Mailing Address - Country:US
Mailing Address - Phone:701-721-3870
Mailing Address - Fax:
Practice Address - Street 1:401 4TH AVE. NORTH EAST
Practice Address - Street 2:
Practice Address - City:BERTHOLD
Practice Address - State:ND
Practice Address - Zip Code:58718
Practice Address - Country:US
Practice Address - Phone:701-453-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND420089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000000000Medicaid