Provider Demographics
NPI:1699366757
Name:ROYSTER, TASHALA SIMPSON (M S, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TASHALA
Middle Name:SIMPSON
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:M S, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 NOLEN RD APT 313
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6977
Mailing Address - Country:US
Mailing Address - Phone:719-362-7565
Mailing Address - Fax:
Practice Address - Street 1:397 TINY TOWN RD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5636
Practice Address - Country:US
Practice Address - Phone:931-999-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist