Provider Demographics
NPI:1790327070
Name:CARSON, TYLER REED (MA-SLP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:REED
Last Name:CARSON
Suffix:
Gender:M
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 1:3201 BRIGHTON BLVD APT 536
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3730
Mailing Address - Country:US
Mailing Address - Phone:828-506-9041
Mailing Address - Fax:
Practice Address - Street 1:3201 BRIGHTON BLVD APT 536
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3730
Practice Address - Country:US
Practice Address - Phone:828-506-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSLP.0000550OtherDORA COLORADO