Active NPI
Jeff Thomas Backlin, CCC-SLP MA
- Speech-Language Pathologist
- Des Moines, IA
National Provider Identifier
1649528233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 002005
- Practice address
- 4725 Merle Hay Rd
Des Moines, IA 50322-1983 - Phone
- (515) 331-3190
- NPI assigned
- Aug 29, 2012
- Sex
- Male
- 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 | 002005 | IA | Primary |
Addresses
Primary practice location
4725 Merle Hay Rd
Des Moines, IA 50322-1983
Mailing address
313 N 13TH St
Indianola, IA 50125-1617
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002005 | IA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346198400000",
"number": "1649528233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 N 13TH ST",
"city": "INDIANOLA",
"state": "IA",
"postal_code": "501251617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4725 MERLE HAY RD",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503221983",
"telephone_number": "515-331-3190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKLIN",
"first_name": "JEFF",
"middle_name": "THOMAS",
"credential": "CCC-SLP MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-29",
"last_updated": "2012-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IA",
"license": "002005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.