Kacey Garcia Poulin, MA,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA5461 Issued in FL

Practice address

4202 E Fowler Ave Pcd2000
Tampa, FL 33620-0001

Phone

(813) 810-1278

NPI assigned

Dec 6, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521763200000",
    "number": "1518472901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE STOP PCD1017",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336206750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE PCD2000",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336200001",
            "telephone_number": "813-810-1278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIN",
        "first_name": "KACEY",
        "middle_name": "GARCIA",
        "credential": "MA,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-06",
        "last_updated": "2018-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA5461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023666900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "S2804",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sangy Paul Pottackal, M.D.
• Frederick Woodbridge Potter, MA
• Matthew Potter, PHARMD
• Lisa M Potthast, PA
• Elizabeth Ann Potts, LCSW
• Eric Pourmand, M.D.
• Fatemeh Pousson, APRN
• Alien D Pouza
• Yudenia De la Caridad Poveda Castro
• Julio Pow-Sang, MD

• Speech-Language Pathologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; 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.