| Organization Name: | THE TINY TIM CENTER, INC. |
| NPI Number: | 1568519320 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATT ELDRED (EXECUTIVE DIRECTOR) |
| Mailing Address: | 611 Korte Way Longmont |
| State: | CO US |
| Postal Code: | 805016366 |
| Phone Number: | 3037767417 |
| Fax Number: | 3037767471 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| 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 |