Active NPI
Mackenzi Ashtyn Potts, MA
- Speech-Language Pathologist
- Plainfield, IN
National Provider Identifier
1104407378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22007733A
- Practice address
- 160 Plainfield Village Dr Ste 101
Plainfield, IN 46168-2782 - Phone
- (855) 324-0885
- Fax
- (317) 520-8200
- NPI assigned
- Apr 19, 2021
- 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 | 22007733A | IN | Primary |
Addresses
Primary practice location
160 Plainfield Village Dr Ste 101
Plainfield, IN 46168-2782
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
Other practice location 1
4655 Rosebud Ln
Newburgh, IN 47630-9366
Phone (855) 324-0885
Other practice location 2
21 S Park Blvd Ste 21
Greenwood, IN 46143-8838
Phone (855) 324-0885
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22007733A | Other | IN | SPEECH LANGUAGE PATHOLOGY |
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22007733A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618790400000",
"number": "1104407378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 PLAINFIELD VILLAGE DR STE 101",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461682782",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
}
],
"practiceLocations": [
{
"address_1": "4655 Rosebud Ln",
"address_purpose": "LOCATION",
"city": "Newburgh",
"state": "IN",
"postal_code": "476309366",
"country_code": "US",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "21 S Park Blvd Ste 21",
"address_purpose": "LOCATION",
"city": "Greenwood",
"state": "IN",
"postal_code": "461438838",
"country_code": "US",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POTTS",
"first_name": "MACKENZI",
"middle_name": "ASHTYN",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-19",
"last_updated": "2021-04-19",
"certification_date": "2021-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22007733A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH LANGUAGE PATHOLOGY",
"identifier": "22007733A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.