Nicole Marie Tillman, MACCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2009013299 Issued in MO

Practice address

2001 N Kingshighway St
Cape Girardeau, MO 63701-2127

Phone

(573) 335-1999

NPI assigned

Jun 10, 2015

Last updated

Oct 18, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powerback Rehabilitation LLCGroup PAC ID 2365359932, 600 clinicians

Synergy Care Southeast LLCGroup PAC ID 6204079163, 193 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Festus, MO
  • NPI 1174344063

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• Synergy Care Southeast, LLC

  dba Synergy Care Southeast LLC - Texas

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1427466614

  MO

  Medicare reassignment Care Compare group
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1790640761

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1780065235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 N KINGSHIGHWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012127",
            "telephone_number": "573-335-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 N KINGSHIGHWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012127",
            "telephone_number": "573-335-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MACCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-10",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2009013299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel L Thompson, MA, PLPC
• Ya'Lita Williams Thompson, LCSW
• William Parr Thorpe, MD
• Minyo Lynne Ticer, FNP-BC
• Lauren Marie Tillman
• Randy Tingwall
• Philip E Tippen, M.D.
• Richard James Tipton, DO
• Danielle Toal, DNP, APRN, FNP-C
• Richard William Tobey, D.O.

• Speech-Language Pathologist in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.