Provider Demographics
NPI:1710796800
Name:PINE BELT VOICE AND SWALLOWING
Entity type:Organization
Organization Name:PINE BELT VOICE AND SWALLOWING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-402-4994
Mailing Address - Street 1:3004 NAVAJO CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2446
Mailing Address - Country:US
Mailing Address - Phone:601-402-4994
Mailing Address - Fax:
Practice Address - Street 1:3004 NAVAJO CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2446
Practice Address - Country:US
Practice Address - Phone:601-402-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty