Active NPI
Caitlin Medeiros, SLP-CCC
- Speech-Language Pathologist
- Clarksville, TN
National Provider Identifier
1104254077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5161
- Practice address
- 851 Professional Park Dr
Clarksville, TN 37040-5257 - Phone
- (423) 622-1551
- Fax
- (877) 856-7133
- NPI assigned
- Oct 31, 2013
- Sex
- Female
- 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 | 5161 | TN | Primary |
Addresses
Primary practice location
851 Professional Park Dr
Clarksville, TN 37040-5257
Mailing address
PO Box 8114
Chattanooga, TN 37414-0114
Phone (423) 622-1551
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5161 | TN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stellar Medical Services, LLC | Past | Accepting new patients | |
| Clarksville-Montgomery County School System | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Local Education Agency (LEA)
- Clarksville, TN
- NPI 1982039657
-
- Nurse Practitioner
- Chattanooga, TN
- NPI 1316433238
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1104254077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8114",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374140114",
"telephone_number": "423-622-1551",
"fax_number": "877-856-7133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 PROFESSIONAL PARK DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370405257",
"telephone_number": "423-622-1551",
"fax_number": "877-856-7133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEIROS",
"first_name": "CAITLIN",
"credential": "SLP-CCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-31",
"last_updated": "2023-06-05",
"certification_date": "2023-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "5161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.