MEDICARE: DR. TYLER DROEGE PSY.D.

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
1	103TC0700X	Clinical Psychologist	2603	KS

General Provider Information

NPI Number	:	1194144469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER DROEGE PSY.D.

Provider Business Mailing Address
First Line	:	411 OAK ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2504
Country	:	US
Telephone Number	:	513-984-1800
Fax Number	:	513-984-4909

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-2504
Country	:	US
Telephone Number	:	913-588-6463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	09/12/2023

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