Basic Information
| Provider Information | |||||||||
| NPI: | 1669746343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STINSON | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | SLPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 W MORROW DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850275533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802323375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25615 N RANCH GATE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852552141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805027726 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2012 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SLPA7668 | AZ | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
| ID | Type | State | Issuer | Description | 444785 | 05 | AZ | MEDICAID | SLPA7668 | 01 | AZ | ARIZONA DEPARTMENT OF HEALTH SERVICES | OTHER |