Provider Demographics
NPI:1194394379
Name:HAWTHORNE, TYLER (AUD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HAWTHORNE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-1817
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-785-4327
Practice Address - Street 1:2501 S W S YOUNG DR STE 106
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2004
Practice Address - Country:US
Practice Address - Phone:254-213-2277
Practice Address - Fax:806-785-4327
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81389237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter