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NPI Code Detail

MEDICARE: DR. TANYE' S. TYLER DSW, LCSW, MBA

MEDICARE: DR. TANYE' S. TYLER DSW, LCSW, MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker33007844AIN
21041C0700XClinical Social Worker149025155IL

General Provider Information

NPI Number : 1427545912
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TANYE' S. TYLER DSW, LCSW, MBA
Provider Business Mailing Address
First Line : 7105 FOREST AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46324-1809
Country : US
Telephone Number : 219-730-9144
Fax Number :
Provider Business Practice Location Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 773-633-0790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 03/14/2024

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