Provider Demographics
NPI:1780999672
Name:STARE, TINA M
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:STARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15135-3201
Mailing Address - Country:US
Mailing Address - Phone:412-751-6305
Mailing Address - Fax:412-751-2476
Practice Address - Street 1:2203 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15135-3201
Practice Address - Country:US
Practice Address - Phone:412-751-6305
Practice Address - Fax:412-751-2476
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001332L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist