Provider Demographics
NPI:1255117057
Name:TINSMAN, EMILY ALLISON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ALLISON
Last Name:TINSMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 IMPERATA ST NE APT 1723
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8027
Mailing Address - Country:US
Mailing Address - Phone:816-832-1656
Mailing Address - Fax:
Practice Address - Street 1:9500 MONTGOMERY BLVD NE STE 215
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2579
Practice Address - Country:US
Practice Address - Phone:505-247-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP-2023-0186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist