Provider Demographics
NPI:1265779573
Name:TYDEMAN, KARIN (SLP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:TYDEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:ANNE
Other - Last Name:SPRAGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2819 RICHMOND DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1918
Mailing Address - Country:US
Mailing Address - Phone:505-883-3787
Mailing Address - Fax:505-830-0106
Practice Address - Street 1:2819 RICHMOND DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1918
Practice Address - Country:US
Practice Address - Phone:505-883-3787
Practice Address - Fax:505-830-0106
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist