Justine Taylor Theisen, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA10918 Issued in FL

Practice address

5811 Bamboo Drive
Fort Pierce, FL 34982-3758

Phone

(772) 242-3187

Fax

(772) 494-7262

NPI assigned

Apr 21, 2011

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 1

Other names 1

• Ms. Justine Lynn Taylor Former name

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": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1598056707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5811 BAMBOO DRIVE",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349823758",
            "telephone_number": "772-242-3187",
            "fax_number": "772-494-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5811 BAMBOO DRIVE",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349823758",
            "telephone_number": "772-242-3187",
            "fax_number": "772-494-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "JUSTINE",
        "middle_name": "TAYLOR",
        "name_prefix": "Mrs.",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-21",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011847300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTINE",
            "last_name": "TAYLOR",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "M.A. CCC-CLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• The Good Samaritan Free Clinic, Inc
• The Hands of Grace and Mercy Alf
• The Haven Detox Ft. Pierce, LLC
• The Lynmoore at Lawnwood Opco, LLC
• The Smile Mission Fort Pierce PLLC
• Therapy Professional Network
• Sainlouitane Theus, D.O.M
• Aquanda Thomas
• Autumn Thomas, MSW
• Jenna Thomas, DO

• Speech-Language Pathologist in Fort Pierce, FL
• Providers in Fort Pierce, 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 Aug 30, 2016; 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.