Provider Demographics
NPI:1326356262
Name:TYNES, ANNETTE LYNN (S-L THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LYNN
Last Name:TYNES
Suffix:
Gender:F
Credentials:S-L THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SHAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039
Mailing Address - Country:US
Mailing Address - Phone:207-657-2066
Mailing Address - Fax:
Practice Address - Street 1:86 INTERVALE RD
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260
Practice Address - Country:US
Practice Address - Phone:207-926-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDOE 293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist