Provider Demographics
NPI:1841546645
Name:LATONA BESTHOFF, TINA C (SLPA)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:C
Last Name:LATONA BESTHOFF
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 E SAGEBRUSH CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2523
Mailing Address - Country:US
Mailing Address - Phone:602-750-7949
Mailing Address - Fax:
Practice Address - Street 1:1561 E SAGEBRUSH CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2523
Practice Address - Country:US
Practice Address - Phone:602-750-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA77232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant