Justin Randal Tucker, MS, CCC/SLP, ATP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

107509 Issued in TX

Practice address

2655 Villa Creek Dr Ste 140
Dallas, TX 75234-7385

Phone

(972) 241-9334

Fax

(972) 241-0155

NPI assigned

Mar 26, 2020

Last updated

Mar 26, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1720615081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 VILLA CREEK DR STE 140",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752347385",
            "telephone_number": "972-241-9334",
            "fax_number": "972-241-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 VILLA CREEK DR STE 140",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752347385",
            "telephone_number": "972-241-9334",
            "fax_number": "972-241-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JUSTIN",
        "middle_name": "RANDAL",
        "credential": "MS, CCC/SLP, ATP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "107509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Tucker, APRN, FNP-C
• Christy Tucker, PHD
• Connie Montgomery Tucker
• Grant M Tucker
• Jaclyn Tucker, PA-C
• Kimberlee Lynn Tucker, B.A.
• Lynde Tucker, DO
• Mary Kathryn Tucker, MS, CCC/SLP
• Rachael Tucker, AGACNP-BC, FNP-BC
• Sheryl Tucker, PT

• Speech-Language Pathologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.