Provider Demographics
NPI:1346455920
Name:TYKOL, JUDY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:TYKOL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24265 CANE BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-6125
Mailing Address - Country:US
Mailing Address - Phone:985-869-4183
Mailing Address - Fax:
Practice Address - Street 1:24265 CANE BYU
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6125
Practice Address - Country:US
Practice Address - Phone:985-869-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324680Medicaid