Provider Demographics
NPI:1063870145
Name:TYSON, LINDA LEE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:TYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HIGH HOPES CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1452
Mailing Address - Country:US
Mailing Address - Phone:615-661-5437
Mailing Address - Fax:
Practice Address - Street 1:301 HIGH HOPES CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1452
Practice Address - Country:US
Practice Address - Phone:615-661-5437
Practice Address - Fax:615-277-2838
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10944235Z00000X
TNSP0000003981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist