Provider Demographics
NPI:1851626618
Name:POITEVINT, TANDI LEIGH (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANDI
Middle Name:LEIGH
Last Name:POITEVINT
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 1:5201 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3146
Mailing Address - Country:US
Mailing Address - Phone:432-631-7242
Mailing Address - Fax:
Practice Address - Street 1:620 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4408
Practice Address - Country:US
Practice Address - Phone:432-332-8244
Practice Address - Fax:432-580-7428
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104163Other- STATE LICENSE NUMBER