Kathryn Tidaback, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

27759 Issued in CA

Practice address

820 Bay Ave Ste 212
Capitola, CA 95010-2103

Phone

(831) 854-2060

NPI assigned

Jun 24, 2020

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Speechrighter, Inc.

  • Speech-Language Pathologist
  • Capitola, CA
  • NPI 1942463823
  NPD (past)

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1821614934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 BROMMER ST",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622807",
            "telephone_number": "520-780-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 BAY AVE STE 212",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "950102103",
            "telephone_number": "831-854-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1031 Brommer St",
            "address_purpose": "LOCATION",
            "city": "Santa Cruz",
            "state": "CA",
            "postal_code": "950622807",
            "country_code": "US",
            "telephone_number": "520-780-0666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDABACK",
        "first_name": "KATHRYN",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "27759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karin Tanaka
• Jenna Teague
• Daniel E Temple, M.D.
• Kent Thompson, M.D.
• Thrifty Payless Inc
• Hong-Nhung Tran, MD
• Michael Tran, PHARMD
• Therese Trolan, M.D.
• Tina Yen Truong, RPH
• Lishanna Echo Tryllium, L.AC.

• Speech-Language Pathologist in Capitola, CA
• Providers in Capitola, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.