Individual provider Active NPI

Jean C. Tucker, M.ED.,CCC-SLP

  • Speech-Language Pathologist
  • Exeter, NH
National Provider Identifier
1770728263
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
0782 Issued in NH
Practice address
92 Portsmouth Ave
Ste 4
Exeter, NH 03833-2133
Phone
(603) 583-4514
Fax
(603) 583-4513
NPI assigned
Dec 11, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

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 0782 NH Primary

Addresses

Primary practice location

92 Portsmouth Ave
Ste 4
Exeter, NH 03833-2133

Mailing address

92 Portsmouth Ave
Ste 4
Exeter, NH 03833-2133
Phone (603) 583-4514

Other identifiers 2

IdentifierTypeStateIssuer
0782OtherNHLICENSED ALLIED HEALTH PROFESSIONALS
30401311MedicaidNH

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
0782NHMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228953600000",
    "number": "1770728263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 PORTSMOUTH AVE",
            "address_2": "STE 4",
            "city": "EXETER",
            "state": "NH",
            "postal_code": "038332133",
            "telephone_number": "603-583-4514",
            "fax_number": "603-583-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 PORTSMOUTH AVE",
            "address_2": "STE 4",
            "city": "EXETER",
            "state": "NH",
            "postal_code": "038332133",
            "telephone_number": "603-583-4514",
            "fax_number": "603-583-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JEAN",
        "middle_name": "C.",
        "credential": "M.ED.,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-11",
        "last_updated": "2008-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NH",
            "license": "0782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED ALLIED HEALTH PROFESSIONALS",
            "identifier": "0782",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30401311",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Exeter, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; 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.