Provider Demographics
NPI:1932617867
Name:VLODICA, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:VLODICA
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 1:20437 WHISTLE PUNK RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2619
Mailing Address - Country:US
Mailing Address - Phone:760-646-6946
Mailing Address - Fax:
Practice Address - Street 1:1569 SW NANCY WAY STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3234
Practice Address - Country:US
Practice Address - Phone:760-646-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health