Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 235Z00000X | Speech-Language Pathologist | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1892 | OTHER | NORTH DAKOTA | NORTH DAKOTA STATE BOARD OF EXAMINERS ON AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY |
| 2 | S52664 | OTHER | SOUTH DAKOTA | MEDICARE |
| 3 | 581-SLP | OTHER | SOUTH DAKOTA | SOUTH DAKOTA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY |
| 4 | 5843992 | MEDICAID | SOUTH DAKOTA | |
| 5 | 12113942 | OTHER | | AMERICAN SPEECH HEARING ASSOCIATION |
| 6 | SLP12665 | OTHER | ARIZONA | ARIZONA DEPARTMENT OF HEALTH SERVICESS |
