Basic Information
| Provider Information | |||||||||
| NPI: | 1154813590 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TYLER | ||||||||
| FirstName: | LEAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032638903 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2145 TIBBETTS DR # A | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986324211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605601972 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 235Z00000X | 61079694 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 17395 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.