Provider Demographics
NPI:1538850466
Name:COPELAND, TYNISHA LASHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:LASHELLE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EASTFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8215
Mailing Address - Country:US
Mailing Address - Phone:404-438-7522
Mailing Address - Fax:
Practice Address - Street 1:140 EASTFIELD CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8215
Practice Address - Country:US
Practice Address - Phone:404-438-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist