Healthcare Provider Details

I. General information

NPI: 1225965221
Provider Name (Legal Business Name): TYLER HECKATHORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44711 CEDAR AVE
LANCASTER CA
93534-3210
US

IV. Provider business mailing address

42473 BISCAY ST
LANCASTER CA
93536-4568
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-4661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: