Tyanna Waddell

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2004012 Issued in NC

Practice address

2722 Hidden Waters Cir
Raleigh, NC 27614-8520

Phone

(919) 465-4424

Fax

(919) 465-4427

NPI assigned

Apr 8, 2020

Last updated

Apr 8, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Expressable Therapy PC

  • Speech-Language Pathologist
  • Austin, TX
  • NPI 1134875370

  GA

  Medicare reassignment NPD
• KM Pediatric Therapy, Inc.

  • Speech-Language Pathologist
  • Cary, NC
  • NPI 1457309932
  NPD (past)
• Lolly Therapeutics, LLC

  • Occupational Therapist
  • Mooresville, NC
  • NPI 1164847752

  Speech-Language Pathologist

  NPD (past)
• A to Z Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Atlanta, GA
  • NPI 1104176718
  NPD (past)

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1548899776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2722 HIDDEN WATERS CIR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148520",
            "telephone_number": "919-465-4424",
            "fax_number": "919-465-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 HIDDEN WATERS CIR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148520",
            "telephone_number": "919-465-4424",
            "fax_number": "919-465-4427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "TYANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "2004012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Valerie Wachter, LCAS, LCMHC
• Brittany Morgan Waddell, RD, LDN, CNSC
• Elizabeth Carlton Waddell, DPT
• Jordan Waddell, CTRS
• Paige Waddell
• Chelsea Waddelow, MMT, MT-BC
• Wade Healthcare Company, Inc.
• Allison Leigh Wade, MS, RD, LDN
• Bryce Wade, APRN
• Cameron Wade

• Speech-Language Pathologist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.