Active NPI
Thomas John List, CCC-SLP
- Speech-Language Pathologist
- Saint Paul, MN
National Provider Identifier
1366951063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9682
- Practice address
- 640 Jackson St
Saint Paul, MN 55101-2502 - Phone
- (651) 254-1065
- NPI assigned
- Sep 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 9682 | MN | Primary |
Addresses
Primary practice location
640 Jackson St
Saint Paul, MN 55101-2502
Mailing address
3517 42ND Ave S
Minneapolis, MN 55406-2812
Phone (715) 204-7881
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 |
|---|---|---|---|
| 9682 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506297600000",
"number": "1366951063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3517 42ND AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554062812",
"telephone_number": "715-204-7881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 JACKSON ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551012502",
"telephone_number": "651-254-1065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIST",
"first_name": "THOMAS",
"middle_name": "JOHN",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-25",
"last_updated": "2017-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.