Provider Demographics
NPI:1134976772
Name:HUBBARD, TRISTAN NICHOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:NICHOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4274 NC 704 HWY E
Mailing Address - Street 2:
Mailing Address - City:SANDY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27046-7647
Mailing Address - Country:US
Mailing Address - Phone:336-402-7881
Mailing Address - Fax:
Practice Address - Street 1:11183 US 70 BUS HWY W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2364
Practice Address - Country:US
Practice Address - Phone:919-243-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist