Tisha S Earnheart – Speech-Language Pathologist

Key facts

NPI: 1790801736
Entity type: Individual (NPI type 1)
Primary specialty: Speech-Language Pathologist 235Z00000X
License: 119688 (MO)
Practice address: 505 Burkhart
Malden, MO 63863
Phone: (573) 276-5791
Fax: (573) 276-4993
NPI assigned: Mar 21, 2007
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Malden R-I School District Local Education Agency (LEA) · Malden, MO · NPI 1225153026

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
119688	MO	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
Malden R-I School District		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Speech-Language Pathologist	235Z00000X	119688	MO	Yes

Addresses

Primary practice location

505 Burkhart
Malden, MO 63863

Mailing address

505 Burkhart
Malden, MO 63863
Phone (573) 276-5791

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790801736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 BURKHART",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "63863",
            "telephone_number": "573-276-5791",
            "fax_number": "573-276-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 BURKHART",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "63863",
            "telephone_number": "573-276-5791",
            "fax_number": "573-276-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EARNHEART",
        "first_name": "TISHA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "119688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malden, MO

All providers in Malden, MO · Speech-Language Pathologist in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.