Active NPI
Tia Antoinette Green
- Speech-Language Pathologist
- Greensboro, NC
National Provider Identifier
1609717222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 30004109
- Practice address
- 714 Green Valley Rd
Greensboro, NC 27408-7018 - Phone
- (336) 370-8100
- NPI assigned
- Apr 6, 2026
- Sex
- Female
- Sole proprietor
- No
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 | 30004109 | NC | Primary |
Addresses
Primary practice location
714 Green Valley Rd
Greensboro, NC 27408-7018
Mailing address
1109 Terrell Dr
High Point, NC 27262-3437
Phone (336) 639-2141
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 |
|---|---|---|---|
| 30004109 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780444800000",
"number": "1609717222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1109 TERRELL DR",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272623437",
"telephone_number": "336-639-2141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 GREEN VALLEY RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274087018",
"telephone_number": "336-370-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "TIA",
"middle_name": "ANTOINETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-04-06",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "30004109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.