Individual provider Active NPI

Lindsey Nicole Tarazona

  • Speech-Language Pathologist
  • Phoenix, AZ
National Provider Identifier
1720388283
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP6377 Issued in AZ
Practice address
12020 S 45TH St
Phoenix, AZ 85044-2436
Phone
(602) 455-6791
NPI assigned
Oct 29, 2010
Last updated
Apr 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP6377 AZ Primary

Addresses

Primary practice location

12020 S 45TH St
Phoenix, AZ 85044-2436

Mailing address

12020 S. 45TH St.
Phoenix, AZ 85044

Other practice location 1

690 E Warner Rd Ste 105
Gilbert, AZ 85296-3055
Phone (480) 820-6366

Other names 1

  • Lindsey Nicole Clarke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191219001378 AZ Practitioner - Qualified Speech Language Pathologist 9032543350 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SLP6377AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mentis Reo, LLC. CurrentSince Jan 11, 2023 Accepting new patients
Heartland Therapy, Inc. CurrentSince Nov 1, 2019 Accepting new patients
Theracare PLLC Speech-Language Pathologist CurrentSince Nov 1, 2019 Accepting new patients
Advanced Therapy Solutions, LLC CurrentSince Jan 11, 2023 Accepting new patients

Locations

1783 E Queen Creek Rd
Ste 1
Chandler, AZ 85286
Phone (480) 820-6366

690 E Warner Rd
Ste 105
Gilbert, AZ 85296
Phone (480) 820-6366

2830 E Brown Rd
Ste 1
Mesa, AZ 85213
Phone (480) 830-1188

530 E McDowell Rd
Ste 107475
Phoenix, AZ 85004

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1720388283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12020 S. 45TH ST.",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12020 S 45TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850442436",
            "telephone_number": "602-455-6791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "690 E Warner Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852963055",
            "country_code": "US",
            "telephone_number": "480-820-6366",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TARAZONA",
        "first_name": "LINDSEY",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-29",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP6377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDSEY",
            "last_name": "CLARKE",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.