Provider Demographics
NPI:1952471005
Name:TYSKLIND, J. MICHAEL (MS,CCC-AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:MICHAEL
Last Name:TYSKLIND
Suffix:
Gender:M
Credentials:MS,CCC-AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT ST # 301A
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-8265
Mailing Address - Fax:515-241-3282
Practice Address - Street 1:1200 PLEASANT ST STE 301A
Practice Address - Street 2:SUITE 308
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-8265
Practice Address - Fax:515-241-8332
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA349237600000X
IA213231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1414375Medicaid