Provider Demographics
NPI:1467676486
Name:VIAN, TRINA K (MACCSLP)
Entity type:Individual
Prefix:MS
First Name:TRINA
Middle Name:K
Last Name:VIAN
Suffix:
Gender:F
Credentials:MACCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1616
Mailing Address - Country:US
Mailing Address - Phone:317-858-0539
Mailing Address - Fax:317-858-0823
Practice Address - Street 1:613 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1616
Practice Address - Country:US
Practice Address - Phone:317-858-0539
Practice Address - Fax:317-858-0823
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003458A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist