Provider Demographics
NPI:1972829448
Name:HAYDEL, TINA H (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:H
Last Name:HAYDEL
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 1:17391 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3724
Mailing Address - Country:US
Mailing Address - Phone:703-888-8397
Mailing Address - Fax:
Practice Address - Street 1:17391 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3724
Practice Address - Country:US
Practice Address - Phone:703-888-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist