Kelly Suzanne Teegardin, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA 7433 Issued in FL

Practice address

4202 E Fowler Ave
PCD 1017
Tampa, FL 33620-6750

Phone

(813) 974-9844

Fax

(813) 974-0822

NPI assigned

Jun 13, 2008

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1740440643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE",
            "address_2": "PCD 1017",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336206750",
            "telephone_number": "813-974-9844",
            "fax_number": "813-974-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEEGARDIN",
        "first_name": "KELLY",
        "middle_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-13",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 7433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000287600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; 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.