Provider Demographics
NPI:1356568562
Name:MYERS, TAMMY L (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:KING, MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-0313
Mailing Address - Country:US
Mailing Address - Phone:479-965-6704
Mailing Address - Fax:479-965-1220
Practice Address - Street 1:500 S GREENWOOD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933
Practice Address - Country:US
Practice Address - Phone:479-965-6704
Practice Address - Fax:479-965-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist