1134463854 NPI number — MR. TYLER JOSHUA FLETCHER M.A., CFY-SLP

Table of content: MR. TYLER JOSHUA FLETCHER M.A., CFY-SLP (NPI 1134463854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134463854 NPI number — MR. TYLER JOSHUA FLETCHER M.A., CFY-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
TYLER
Provider Middle Name:
JOSHUA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CFY-SLP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134463854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 AMBERWOOD DRIVE
Provider Second Line Business Mailing Address:
APARTMENT 10
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-340-6409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 AMBERWOOD DR
Provider Second Line Business Practice Location Address:
APARTMENT 10
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-340-6409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  350 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com