Provider Demographics
NPI:1932175171
Name:KORDES, TAMMY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LYNN
Last Name:KORDES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-877-8013
Mailing Address - Fax:814-877-8007
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-877-8013
Practice Address - Fax:814-877-8007
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-015999-L103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ67245Medicare UPIN
PAQ67245Medicare UPIN