Tabetha Nicole Mathiesen, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3775 Issued in OK

Practice address

205 E Cimarron Blvd
Crescent, OK 73028-9296

Phone

(405) 795-7110

NPI assigned

Sep 11, 2012

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 names 1

• Ms. Tabetha Nicole Kraeutner Former name

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.

• Wholistic Therapy LLC

  • Speech-Language Pathologist
  • Guthrie, OK
  • NPI 1457740888
  NPD (past) Authorized official

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373500800000",
    "number": "1093065682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E CIMARRON BLVD",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289296",
            "telephone_number": "405-795-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E CIMARRON BLVD",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289296",
            "telephone_number": "405-795-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIESEN",
        "first_name": "TABETHA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-11",
        "last_updated": "2013-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "3775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TABETHA",
            "last_name": "KRAEUTNER",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "MS CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dana K Larue
• Kyle N Lipke, PA
• Logan Hospital and Medical Center Authority
• Logsdon Lotz Drug Inc
• Ltcnp
• Theresa Lynn McCartney
• Mercy Hospital Logan County, Inc
• Next Plan, LLC
• Amber Dawn Taylor
• Janson P Varghese, APNP

• Speech-Language Pathologist in Crescent, OK
• Providers in Crescent, OK by specialty
• Speech-Language Pathologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; 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.