Provider Demographics
NPI:1225019177
Name:TIPLER, TAVEDIA DUNLAP (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAVEDIA
Middle Name:DUNLAP
Last Name:TIPLER
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 1:1220 FLEETWOOD COVE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0621
Mailing Address - Country:US
Mailing Address - Phone:817-899-3696
Mailing Address - Fax:866-547-8848
Practice Address - Street 1:2406 CRIPPLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-1848
Practice Address - Country:US
Practice Address - Phone:817-899-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2715235Z00000X
MSS2396235Z00000X
TX103661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist