Taytum Fay Fuller, MS, CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

61160992 Issued in WA

Practice address

123 W Cascade Way
Spokane, WA 99208-6017

Phone

(509) 624-3115

Fax

(509) 624-4374

NPI assigned

Jun 1, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Autism Center

  • Community/Behavioral Health Agency
  • Spokane, WA
  • NPI 1134557390
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1023684073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2347 S SOUTHEAST BLVD APT 4",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992034535",
            "telephone_number": "509-793-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W CASCADE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086017",
            "telephone_number": "509-624-3115",
            "fax_number": "509-624-4374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TAYTUM",
        "middle_name": "FAY",
        "credential": "MS, CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "61160992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "LL61304692",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "josee@inlandnorthwesttherapy.org",
            "affiliation": "Y",
            "affiliationName": "Knights Therapy",
            "address_1": "9425 N Nevada St Ste 100",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992181286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Debra Johnson Fuller, ARNP
• Donald R Fuller, CCC-SLP
• Evan D Fuller, PHARMD
• Jeremy R Fuller, CRNA
• Kaylee Fuller
• Cari Leann Fullerton, COTA
• Greg L. Fullmer, AGNP-C
• Kurt D Fullmer, PA-C
• Megan Erin Funchess, RN
• Function First OT, PLLC (Function First OT)

• Speech-Language Pathologist in Spokane, WA
• Providers in Spokane, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.