1952471005 NPI number — MR. J. MICHAEL TYSKLIND M.S.,CCC-AUDIOLOGIST

Table of content: MR. J. MICHAEL TYSKLIND M.S.,CCC-AUDIOLOGIST (NPI 1952471005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952471005 NPI number — MR. J. MICHAEL TYSKLIND M.S.,CCC-AUDIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYSKLIND
Provider First Name:
J.
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,CCC-AUDIOLOGIST
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:
1952471005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 PLEASANT ST # 301A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-8265
Provider Business Mailing Address Fax Number:
515-241-3282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 PLEASANT ST STE 301A
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-8265
Provider Business Practice Location Address Fax Number:
515-241-8332
Provider Enumeration Date:
11/08/2006

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: 237600000X , with the licence number:  349 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 213 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1414375 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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