Provider Demographics
NPI:1205087186
Name:HAYNIE, TABITHA STAR (MS, CFY-SLP)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:STAR
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 E 21ST ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3940
Mailing Address - Country:US
Mailing Address - Phone:575-309-6324
Mailing Address - Fax:
Practice Address - Street 1:2221 DILLON RD
Practice Address - Street 2:RETIREMENT RANCH INC OF CLOVIS
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9454
Practice Address - Country:US
Practice Address - Phone:575-762-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist