Active NPI
Tina Saunders, MCCC/SLP
- Speech-Language Pathologist
- Lakeland, FL
National Provider Identifier
1114940616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA 8410
- Practice address
- 1311 Lake Deeson PT
Lakeland, FL 33805-9213 - Phone
- (813) 477-7624
- Fax
- (863) 802-1802
- NPI assigned
- Jul 25, 2006
- 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 | SA 8410 | FL | Primary |
Addresses
Primary practice location
1311 Lake Deeson PT
Lakeland, FL 33805-9213
Mailing address
1311 Lake Deeson PT
Lakeland, FL 33805-9213
Phone (813) 477-7624
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 889864200 | Medicaid | FL | |
| 812207500 | Medicaid | FL |
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 |
|---|---|---|---|
| SA 8410 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1114940616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 LAKE DEESON PT",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338059213",
"telephone_number": "813-477-7624",
"fax_number": "863-802-1802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 LAKE DEESON PT",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338059213",
"telephone_number": "813-477-7624",
"fax_number": "863-802-1802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAUNDERS",
"first_name": "TINA",
"credential": "MCCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA 8410",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "889864200",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "812207500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.