Provider Demographics
NPI:1336870898
Name:MILLARD, TYLER (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MILLARD
Suffix:
Gender:M
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52089 HIGHWAY 6 APT A211
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-2823
Mailing Address - Country:US
Mailing Address - Phone:435-414-4304
Mailing Address - Fax:
Practice Address - Street 1:400 SOPRIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2038
Practice Address - Country:US
Practice Address - Phone:623-289-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
COSLP.0005460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist