Provider Demographics
NPI:1073194841
Name:TATUM, LYNDSEY GARRISON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSEY
Middle Name:GARRISON
Last Name:TATUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 PLAMERA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2009
Mailing Address - Country:US
Mailing Address - Phone:706-836-9008
Mailing Address - Fax:
Practice Address - Street 1:7500 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1505
Practice Address - Country:US
Practice Address - Phone:817-514-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist