Provider Demographics
NPI:1891064259
Name:BAUMGARDNER, TYELINDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TYELINDA
Middle Name:
Last Name:BAUMGARDNER
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 1:10042 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7329
Mailing Address - Country:US
Mailing Address - Phone:405-613-5367
Mailing Address - Fax:405-942-4895
Practice Address - Street 1:2416 N ANN ARBOR AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1811
Practice Address - Country:US
Practice Address - Phone:405-942-4895
Practice Address - Fax:405-942-4895
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist