Elizabeth C Tickle, MA CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8021 Issued in MN

Practice address

900 West 94TH St
Bloomington, MN 55420

Phone

(952) 885-0418

Fax

(952) 885-0173

NPI assigned

Sep 27, 2006

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 names 1

• Miss Elizabeth G Cruse Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Family Achievement Center Inc.

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  • Woodbury, MN
  • NPI 1952411175

  Speech-Language Pathologist

  Medicare reassignment NPD
• The Therapy Place

  • Rehabilitation Clinic/Center
  • Bloomington, MN
  • NPI 1609934173
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1609967223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 ALTON ST #212",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55116",
            "telephone_number": "651-247-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WEST 94TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55420",
            "telephone_number": "952-885-0418",
            "fax_number": "952-885-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKLE",
        "first_name": "ELIZABETH",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "MA CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "8021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "CRUSE",
            "middle_name": "G",
            "prefix": "MISS",
            "credential": "MA CCC/SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.