Provider Demographics
NPI:1225178601
Name:HAMPTON, TY JOSEPH (MS)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:JOSEPH
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 E 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3910
Mailing Address - Country:US
Mailing Address - Phone:907-344-8255
Mailing Address - Fax:907-344-8250
Practice Address - Street 1:3030 E 88TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3910
Practice Address - Country:US
Practice Address - Phone:907-344-8255
Practice Address - Fax:907-344-8250
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1570972Medicaid
AKMPG0076Medicaid
AK5061Medicaid