Darrell James Dern, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0250 Issued in AZ

Practice address

16036 N 11TH Ave Unit 1112
Phoenix, AZ 85023-8207

Phone

(602) 315-4171

NPI assigned

May 25, 2007

Last updated

Jun 25, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1659582153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16036 N 11TH AVE UNIT 1112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850238207",
            "telephone_number": "602-315-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16036 N 11TH AVE UNIT 1112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850238207",
            "telephone_number": "602-315-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERN",
        "first_name": "DARRELL",
        "middle_name": "JAMES",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "0250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.

Verify at the official NPI Registry.