Provider Demographics
NPI:1366983926
Name:DEAN, TINA RENAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:RENAE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:RENAE
Other - Last Name:SKEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1101 E COOK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8368
Mailing Address - Country:US
Mailing Address - Phone:734-216-6193
Mailing Address - Fax:
Practice Address - Street 1:2413 S LINDEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5428
Practice Address - Country:US
Practice Address - Phone:810-733-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist