Provider Demographics
NPI:1366698805
Name:HIBBS, TINA MARIE (MS,CCC/SLP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:HIBBS
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 1:3065 BUFFALO TRCE
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8670
Mailing Address - Country:US
Mailing Address - Phone:270-836-4727
Mailing Address - Fax:270-825-6031
Practice Address - Street 1:3065 BUFFALO TRCE
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8670
Practice Address - Country:US
Practice Address - Phone:270-836-4727
Practice Address - Fax:270-825-6031
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist