Provider Demographics
NPI:1932650363
Name:PONCIN, TINA (MS CFY-SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PONCIN
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PRAY
Mailing Address - State:MT
Mailing Address - Zip Code:59065-0010
Mailing Address - Country:US
Mailing Address - Phone:406-220-3699
Mailing Address - Fax:
Practice Address - Street 1:485 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:PRAY
Practice Address - State:MT
Practice Address - Zip Code:59065-0010
Practice Address - Country:US
Practice Address - Phone:406-220-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-TMP-5947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist