Provider Demographics
NPI:1285067876
Name:CHOATE, TYLER PERE (MS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:PERE
Last Name:CHOATE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 W DIVERSEY PKWY
Mailing Address - Street 2:APT 603
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1874
Mailing Address - Country:US
Mailing Address - Phone:337-255-6324
Mailing Address - Fax:
Practice Address - Street 1:400 N. MAY STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:773-255-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist