Tricore Speech LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

112012 Issued in MO

Legal business name

TRICORE SPEECH LLC

Practice address

4491 Bessie Ave
Saint Louis, MO 63115-2707

Phone

(314) 660-1690

Fax

(314) 389-4820

NPI assigned

Dec 27, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Andrea Denice Campbell-Williams, CCC-SLPNPI 1164564175

Title

Speech Language Pathologist/Manager

Phone

(314) 660-1690

Specialties & licenses 1

Addresses

Practitioners 1

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

• Andrea Denice Campbell-Williams, M.A., CCC-SLP

  • Speech-Language Pathologist
  • St. Louis, MO
  • NPI 1164564175
  NPD (past) Authorized official

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

{
    "created_epoch": "1356566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356566400000",
    "number": "1215273990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4491 BESSIE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152707",
            "telephone_number": "314-660-1690",
            "fax_number": "314-389-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4491 BESSIE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631152707",
            "telephone_number": "314-660-1690",
            "fax_number": "314-389-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICORE SPEECH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-27",
        "last_updated": "2012-12-27",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL-WILLIAMS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "DENICE",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST/MANAGER",
        "authorized_official_telephone_number": "314-660-1690",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "112012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Speech-Language Pathologist in Missouri

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

Verify at the official NPI Registry.