Active NPI
Marla Caudle
- Speech-Language Pathologist
- Tyler, TX
National Provider Identifier
1770319725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 121055
- Practice address
- 3310 S Broadway Ave Ste 100I
Tyler, TX 75701-7818 - Phone
- (903) 781-1832
- NPI assigned
- Sep 9, 2024
- Sex
- Female
- 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 | 121055 | TX | Primary |
Addresses
Primary practice location
3310 S Broadway Ave Ste 100I
Tyler, TX 75701-7818
Mailing address
19142 Big Timber Rd
Tyler, TX 75703-8610
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121055 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bo Keeling, PLLC | Speech-Language Pathologist | Current | Accepting new patients |
Locations
3310 S Broadway Ave
Ste 100I
Tyler, TX 75701
Phone (903) 780-3505
3310 S Broadway Ave
Ste 100
Tyler, TX 75701
Phone (903) 781-1832
Organizations & group practices 1
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": "1725840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725840000000",
"number": "1770319725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19142 BIG TIMBER RD",
"city": "TYLER",
"state": "TX",
"postal_code": "757038610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3310 S BROADWAY AVE STE 100I",
"city": "TYLER",
"state": "TX",
"postal_code": "757017818",
"telephone_number": "903-781-1832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAUDLE",
"first_name": "MARLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-09",
"last_updated": "2024-09-09",
"certification_date": "2024-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "121055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.