Provider Demographics
NPI:1770291619
Name:CHRISTOPULOS, TYLER TONY (PHD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:TONY
Last Name:CHRISTOPULOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S WAKARA WAY STE 1112
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1448
Mailing Address - Country:US
Mailing Address - Phone:801-581-3506
Mailing Address - Fax:801-585-6127
Practice Address - Street 1:417 S WAKARA WAY STE 1112
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1448
Practice Address - Country:US
Practice Address - Phone:801-581-3506
Practice Address - Fax:801-585-6127
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13097402-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist