Provider Demographics
NPI:1639525470
Name:ARNOLD, TYLER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:LAUREN
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4180 BOWEN WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6238
Mailing Address - Country:US
Mailing Address - Phone:757-506-5168
Mailing Address - Fax:
Practice Address - Street 1:4180 BOWEN WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6238
Practice Address - Country:US
Practice Address - Phone:757-506-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist