Provider Demographics
NPI:1881351997
Name:WORKMAN, TRISTAN TYLER
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:TYLER
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28972 OAK HILL LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6848
Mailing Address - Country:US
Mailing Address - Phone:909-936-5730
Mailing Address - Fax:
Practice Address - Street 1:28972 OAK HILL LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6848
Practice Address - Country:US
Practice Address - Phone:909-936-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant