Provider Demographics
NPI:1679082481
Name:OERTEL, TAMMY LYNN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:OERTEL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32633 DELHI RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62012-4000
Mailing Address - Country:US
Mailing Address - Phone:618-541-8495
Mailing Address - Fax:
Practice Address - Street 1:201 E CITY LIMITS RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:IL
Practice Address - Zip Code:62012-2344
Practice Address - Country:US
Practice Address - Phone:618-372-3813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist