Provider Demographics
NPI:1962420893
Name:WORMAN, TINA D (MS)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:D
Last Name:WORMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4022
Practice Address - Fax:206-598-6611
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002192231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU34574OtherREGENCE BLUESHIELD
WA127751OtherLABOR & INDUSTRY
WA8338253Medicaid
WA127751OtherLABOR & INDUSTRY