Provider Demographics
NPI:1932626702
Name:MCCOY, TISHA JO
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:JO
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:JO
Other - Last Name:KREAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4109
Mailing Address - Country:US
Mailing Address - Phone:740-403-7157
Mailing Address - Fax:
Practice Address - Street 1:145 N QUENTIN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4623
Practice Address - Country:US
Practice Address - Phone:740-349-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist