MEDICARE: MRS. TRINA ELAINE ARD CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18235	TX

General Provider Information

NPI Number	:	1902186398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINA ELAINE ARD CCC-SLP

Provider Business Mailing Address
First Line	:	1434 CHASE OAKS DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-7207
Country	:	US
Telephone Number	:	817-896-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	5411 BASSWOOD BLVD
Second Line	:	SUITE 221
City	:	FT WORTH
State	:	TX
Zip	:	76137-4477
Country	:	US
Telephone Number	:	817-514-6333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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