Individual provider Active NPI

Tyler Young, M.S., CF-SLP

  • Speech-Language Pathologist
  • Westmont, IL
National Provider Identifier
1790201515
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146.013974 Issued in IL
Practice address
6501 S Cass Ave
Westmont, IL 60559-3200
Phone
(630) 960-2026
NPI assigned
Aug 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 146.013974 IL Primary

Addresses

Primary practice location

6501 S Cass Ave
Westmont, IL 60559-3200

Mailing address

724 Adams St
Bolingbrook, IL 60440-2604

Other practice location 1

2180 Manchester Rd
Wheaton, IL 60187-4580
Phone (630) 665-4330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191125001954 IL Practitioner - Qualified Speech Language Pathologist 3375976780 Reassigns benefits to 1 organization
I20210712002018 IN Practitioner - Qualified Speech Language Pathologist 3375976780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7 Carnegie PLZ
Cherry Hill, NJ 08003-1000

7 Clyde Rd
Somerset, NJ 08873-5049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
146.013974ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehabilitation Services Il LLC Speech-Language Pathologist CurrentSince Nov 1, 2019 Accepting new patients
Fox Rehab Indiana LLC Speech-Language Pathologist CurrentSince Jun 1, 2021 Accepting new patients

Locations

14901 Carey Rd
Carmel, IN 46033

7 Carnegie Plz
Cherry Hill, NJ 08003

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1790201515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 ADAMS ST",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 S CASS AVE",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605593200",
            "telephone_number": "630-960-2026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2180 Manchester Rd",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "601874580",
            "country_code": "US",
            "telephone_number": "630-665-4330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "TYLER",
        "credential": "M.S., CF-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.013974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westmont, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.