Amy Thistle Tackett, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

21919 Issued in CA

Practice address

298 Patton Pkwy
Marina, CA 93933-6007

Phone

(831) 220-1763

NPI assigned

Jun 2, 2026

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1780358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1831021971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 MCCULLOCH CIR",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939332404",
            "telephone_number": "831-220-1763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 PATTON PKWY",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939336007",
            "telephone_number": "831-220-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "AMY",
        "middle_name": "THISTLE",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-02",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "21919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Bret Sullivan, DC
• Erin Sullivan, NP
• Suzie Sullivan, LCSW
• Sun Street Centers
• Amanda Swift, B.C.B.A.
• Momoko Takeda, LMFT
• Lioudmila Tarbox, FNP
• Leah Taylor
• Monique Theaker
• Michelle Thomas, LCSW

• All providers in Marina, CA
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.