Janessa Lynn Tidwell, CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

TSLP12279 Issued in MO

Practice address

13575 W McDowell Rd
Goodyear, AZ 85395-2604

Phone

(623) 536-9911

NPI assigned

Feb 27, 2020

Last updated

Feb 27, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Word Play, LLC

  • Home Health Agency
  • Phoenix, AZ
  • NPI 1184806960

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1114551231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12376 W DEVONSHIRE AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924258",
            "telephone_number": "417-650-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13575 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952604",
            "telephone_number": "623-536-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JANESSA",
        "middle_name": "LYNN",
        "credential": "CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "TSLP12279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Nicole Thompson, D.C.
• Stephanie Thompson, FNP-C
• Tiffany Thornhill
• Yvette Thorson, PA
• John W Thuerck III, DC
• Mary Lynn Tieszen, F.N.P.
• Doris Tih, NP
• Brooke Tillia, CRNA
• Lucas A Tims, N.D.
• Charlise Tindle, LLPC

• Speech-Language Pathologist in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.