Provider Demographics
NPI:1346719598
Name:TYSON, TAMEKA ANDERSON
Entity Type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:ANDERSON
Last Name:TYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 LUCINDA LN
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9367
Mailing Address - Country:US
Mailing Address - Phone:269-463-0860
Mailing Address - Fax:
Practice Address - Street 1:433 LUCINDA LN
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9367
Practice Address - Country:US
Practice Address - Phone:269-463-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist