Provider Demographics
NPI:1285237172
Name:DEPRIEST, TYLEASE MECHELLE (MA CF-SLP)
Entity type:Individual
Prefix:
First Name:TYLEASE
Middle Name:MECHELLE
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 N MILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1670
Mailing Address - Country:US
Mailing Address - Phone:817-470-1241
Mailing Address - Fax:
Practice Address - Street 1:1313 S HIGH ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3751
Practice Address - Country:US
Practice Address - Phone:316-320-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist