Provider Demographics
NPI:1063664670
Name:TYLER SPEECH IMPROVEMENT SERVICES
Entity Type:Organization
Organization Name:TYLER SPEECH IMPROVEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC
Authorized Official - Phone:903-531-2581
Mailing Address - Street 1:401 E FRONT ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8213
Mailing Address - Country:US
Mailing Address - Phone:903-531-2581
Mailing Address - Fax:903-531-2451
Practice Address - Street 1:401 E FRONT ST
Practice Address - Street 2:SUITE 123
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8213
Practice Address - Country:US
Practice Address - Phone:903-531-2581
Practice Address - Fax:903-531-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149086402Medicaid
TX152131OtherCHIP