Provider Demographics
NPI:1689244360
Name:COLDIRON, TYLER (CF SPEECH THERAPY)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COLDIRON
Suffix:
Gender:M
Credentials:CF SPEECH THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FRIENDSHIP CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-6920
Mailing Address - Country:US
Mailing Address - Phone:770-240-0163
Mailing Address - Fax:770-240-0163
Practice Address - Street 1:1715 FRIENDSHIP CIR STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6920
Practice Address - Country:US
Practice Address - Phone:770-240-0163
Practice Address - Fax:770-240-0163
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET0033622355S0801X
GASLP012024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant