Expression Pediatric Therapy, PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

EXPRESSION PEDIATRIC THERAPY, PLLC

Practice address

1340 W Villard St Ste a
Dickinson, ND 58601-4632

Phone

(701) 590-9116

NPI assigned

Feb 13, 2020

Organization subpart

No

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

Authorized official

Name

Mackenzie M Woodworth, MSNPI 1285161554

Title

Speech-Language Pathologist

Phone

(509) 981-3998

Specialties & licenses 3

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mackenzie M Woodworth, MS, CCC-SLP

  • Speech-Language Pathologist
  • Dickinson, ND
  • NPI 1285161554
  NPD Authorized official
• Meghan Ackerman

  • Speech-Language Pathologist
  • Dickinson, ND
  • NPI 1346039740
  NPD
• Tessa Nelson, MS, CF-SLP

  • Speech-Language Pathologist
  • Dickinson, ND
  • NPI 1477272763
  NPD

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705795200000",
    "number": "1164055513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2212 3RD ST W",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012414",
            "telephone_number": "509-981-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 W VILLARD ST STE A",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014632",
            "telephone_number": "701-590-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESSION PEDIATRIC THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-13",
        "last_updated": "2024-01-21",
        "certification_date": "2024-01-21",
        "status": "A",
        "authorized_official_last_name": "WOODWORTH",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "509-981-3998",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brooke Jade Fahsholtz, LCAC
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• All providers in Dickinson, ND
• Speech-Language Pathologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2024; 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.