Provider Demographics
NPI:1518272178
Name:TILLINGHAST, TRICIA LEE (MA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LEE
Last Name:TILLINGHAST
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1845
Mailing Address - Country:US
Mailing Address - Phone:315-690-3712
Mailing Address - Fax:315-342-9599
Practice Address - Street 1:10 BURKLE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3259
Practice Address - Country:US
Practice Address - Phone:315-342-4600
Practice Address - Fax:315-342-9599
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020360-01235Z00000X
NY58 020360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist