Active NPI
Ted Matthew Isaacson, MS CCC SLP
- Speech-Language Pathologist
- Lompoc, CA
National Provider Identifier
1043385727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP12824
- Practice address
- 191 West Burton Mesa Blvd
Suite B
Lompoc, CA 93436 - Phone
- (805) 733-4542
- Fax
- (805) 733-4392
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP12824 | CA | Primary |
Addresses
Primary practice location
191 West Burton Mesa Blvd
Suite B
Lompoc, CA 93436
Mailing address
108 N Z St
Lompoc, CA 93436
Phone (805) 736-0363
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0663623 | Other | CA | TRIWEST |
| GSP000390 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP12824 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043385727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 N Z ST",
"city": "LOMPOC",
"state": "CA",
"postal_code": "93436",
"telephone_number": "805-736-0363",
"fax_number": "805-736-0363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 WEST BURTON MESA BLVD",
"address_2": "SUITE B",
"city": "LOMPOC",
"state": "CA",
"postal_code": "93436",
"telephone_number": "805-733-4542",
"fax_number": "805-733-4392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISAACSON",
"first_name": "TED",
"middle_name": "MATTHEW",
"credential": "MS CCC SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP12824",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIWEST",
"identifier": "0663623",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GSP000390",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lompoc, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.