| Doctor Name: | TINA LANETTE VINE |
| NPI Number: | 1669538005 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MACCCSLP |
| License Number: | SP0000001960 |
| Business Practice Address: | 175 Hospital Dr Mc Kenzie, TN - 382011636 |
| Business Phone Number: | 7313523908 |
| Business Fax Number: | 7313524579 |
| Mailing Address: | 327 Head St, PARIS |
| State: | TN |
| Postal Code: | 382424140 |
| Phone Number: | 7316427439 |
| Fax Number: | 7316429447 |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP0000001960 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |