Provider Demographics
NPI:1013499854
Name:TYYNISMAA, ANDREW (HIS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:TYYNISMAA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RED CEDAR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2338
Mailing Address - Country:US
Mailing Address - Phone:715-235-3191
Mailing Address - Fax:
Practice Address - Street 1:392 RED CEDAR ST STE 3
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2338
Practice Address - Country:US
Practice Address - Phone:715-235-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1560-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI23770000023Medicaid