Active NPI
Oksana Alexandrovna Tetrick III
- Speech-Language Assistant
- Sandwich, IL
National Provider Identifier
1396462107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 217.000449
- Practice address
- 452 Meadowlark Cir Apt a
Sandwich, IL 60548-9561 - Phone
- (815) 570-1977
- NPI assigned
- Oct 21, 2022
- Last updated
- Oct 21, 2022
- Sex
- Female
- 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 Assistant | 2355S0801X | 217.000449 | IL | Primary |
Addresses
Primary practice location
452 Meadowlark Cir Apt a
Sandwich, IL 60548-9561
Mailing address
452 Meadowlark Cir Apt a
Sandwich, IL 60548-9561
Phone (815) 570-1977
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 |
|---|---|---|---|
| 217.000449 | IL | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1396462107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "452 MEADOWLARK CIR APT A",
"city": "SANDWICH",
"state": "IL",
"postal_code": "605489561",
"telephone_number": "815-570-1977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "452 MEADOWLARK CIR APT A",
"city": "SANDWICH",
"state": "IL",
"postal_code": "605489561",
"telephone_number": "815-570-1977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETRICK",
"first_name": "OKSANA",
"middle_name": "ALEXANDROVNA",
"name_prefix": "Ms.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-21",
"last_updated": "2022-10-21",
"certification_date": "2022-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "IL",
"license": "217.000449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandwich, IL
- Lindsey Nicole Fae Smith, LCSW
- Penelope Spiekerman, DDS
- Maria Dana Sutkus, DO
- Jahangir Tai, D.O.
- Shawn Michael Tessmer, BA, MA, LCPC
- The Brain Clinic, LLC
- Trinity Women's Health Care SC
- Valley West Community Hospital
- Valley West Community Hospital
- Valley West Community Hospital (Northwestern Medicine Valley West Hospital)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.