Individual provider Active NPI

Tiffany Chere' Nettles, M.S.CCC-SLP

  • Speech-Language Pathologist
  • Washington, DC
National Provider Identifier
1124151543
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
03788 Issued in MD
Practice address
525 Bryant St NW
Room 139Y
Washington, DC 20059-1005
Phone
(202) 806-6991
Fax
(202) 387-1327
NPI assigned
Mar 14, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 03788 MD Primary

Addresses

Primary practice location

525 Bryant St NW
Room 139Y
Washington, DC 20059-1005

Mailing address

2024 Georgia Ave NW
Washington, DC 20001-3027
Phone (202) 265-6679

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
03788MDMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Howard University Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1124151543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 GEORGIA AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200013027",
            "telephone_number": "202-265-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BRYANT ST NW",
            "address_2": "ROOM 139Y",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200591005",
            "telephone_number": "202-806-6991",
            "fax_number": "202-387-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "TIFFANY",
        "middle_name": "CHERE'",
        "name_prefix": "Mrs.",
        "credential": "M.S.CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "03788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; 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.