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Individual
MRS. FREDDY G TISDALE
Active
Individual
MRS. FREDDY G TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12008332
LA
235Z00000X
Speech-Language Pathologist
4135
LA
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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