Doctor Name: | TYLER BLACK |
NPI Number: | 1164683033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 2202005520 |
Business Practice Address: | 185 Charlois Blvd Winston Salem, NC - 271031521 |
Business Phone Number: | 3367250222 |
Business Fax Number: | 8777250222 |
Mailing Address: | 185 Charlois Blvd, WINSTON SALEM |
State: | NC |
Postal Code: | 271031521 |
Phone Number: | 3367250222 |
Fax Number: | 8777250222 |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 10/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2202005520 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |