Healthcare Provider Details

I. General information

NPI: 1952471005
Provider Name (Legal Business Name): J. MICHAEL TYSKLIND M.S.,CCC-AUDIOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST STE 301A SUITE 308
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1200 PLEASANT ST # 301A
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-8265
  • Fax: 515-241-8332
Mailing address:
  • Phone: 515-241-8265
  • Fax: 515-241-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number213
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number349
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: