Active NPI
Timothy Clyde Earls, MS CCC-SLP
- Speech-Language Pathologist
- Dayton, OH
National Provider Identifier
1083479471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP.03787
- Practice address
- 3871 Yellowstone Ave
Dayton, OH 45416-2236 - Phone
- (937) 542-5390
- NPI assigned
- Feb 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | SP.03787 | OH | Primary |
Addresses
Primary practice location
3871 Yellowstone Ave
Dayton, OH 45416-2236
Mailing address
455 Rosetta St
New Lebanon, OH 45345-1519
Phone (937) 681-8318
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 |
|---|---|---|---|
| SP.03787 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1083479471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 ROSETTA ST",
"city": "NEW LEBANON",
"state": "OH",
"postal_code": "453451519",
"telephone_number": "937-681-8318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3871 YELLOWSTONE AVE",
"city": "DAYTON",
"state": "OH",
"postal_code": "454162236",
"telephone_number": "937-542-5390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EARLS",
"first_name": "TIMOTHY",
"middle_name": "CLYDE",
"credential": "MS CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-15",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP.03787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.