Healthcare Provider Details

I. General information

NPI: 1356754535
Provider Name (Legal Business Name): TINA TARVER LBA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 152ND AVE NE
REDMOND WA
98052-5552
US

IV. Provider business mailing address

1915 140TH AVE NE STE D2146
BELLEVUE WA
98005-2347
US

V. Phone/Fax

Practice location:
  • Phone: 425-429-4793
  • Fax: 844-384-9206
Mailing address:
  • Phone: 425-429-4793
  • Fax: 844-384-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number607691
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL 00004760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: