Provider Demographics
NPI:1992064562
Name:MCREYNOLDS, TAMARA (SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4706
Mailing Address - Country:US
Mailing Address - Phone:319-483-8584
Mailing Address - Fax:
Practice Address - Street 1:700 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2331
Practice Address - Country:US
Practice Address - Phone:608-326-1434
Practice Address - Fax:608-326-1435
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3631-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist