Provider Demographics
NPI:1801656624
Name:CASE, TYSON (HIS)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:CASE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8014
Mailing Address - Country:US
Mailing Address - Phone:866-935-9487
Mailing Address - Fax:208-542-1112
Practice Address - Street 1:1970 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8014
Practice Address - Country:US
Practice Address - Phone:866-935-9487
Practice Address - Fax:208-542-1112
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-4152237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist