Provider Demographics
NPI:1902186398
Name:ARD, TRINA ELAINE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:ELAINE
Last Name:ARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 CHASE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7207
Mailing Address - Country:US
Mailing Address - Phone:817-896-2621
Mailing Address - Fax:
Practice Address - Street 1:5411 BASSWOOD BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4477
Practice Address - Country:US
Practice Address - Phone:817-514-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist