Provider Demographics
NPI:1144115619
Name:WEAVER, TYLER WAYNE (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WAYNE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 BOVINE DR APT 9106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0047
Mailing Address - Country:US
Mailing Address - Phone:662-202-8204
Mailing Address - Fax:
Practice Address - Street 1:116 RIVER OAKS DR STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7087
Practice Address - Country:US
Practice Address - Phone:972-745-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81764231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist