Provider Demographics
NPI:1962503565
Name:JUAREZ, TINA FAYE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:FAYE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 MIAMI ST STE A
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1934
Mailing Address - Country:US
Mailing Address - Phone:419-448-5533
Mailing Address - Fax:419-448-5559
Practice Address - Street 1:676 MIAMI ST STE A
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1934
Practice Address - Country:US
Practice Address - Phone:419-448-5533
Practice Address - Fax:419-448-5559
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist