Provider Demographics
NPI:1013764828
Name:JAREMKO, TINA MELAMED (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:MELAMED
Last Name:JAREMKO
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:CECILE
Other - Last Name:MELAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:2759 S CHILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5316
Mailing Address - Country:US
Mailing Address - Phone:832-594-6138
Mailing Address - Fax:
Practice Address - Street 1:3310 S BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7851
Practice Address - Country:US
Practice Address - Phone:903-781-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist