Dana Marie Tiebout, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

004894 Issued in CT

Practice address

247 Rhodes Rd
Tolland, CT 06084-3568

Phone

(860) 870-6750

NPI assigned

Dec 10, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dana Marie Andreoli Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Nashoba Learning Group, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Bedford, MA
  • NPI 1508131483
  NPD (past)

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1831564236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 CRYSTAL RIDGE DR",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060842165",
            "telephone_number": "203-804-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 RHODES RD",
            "city": "TOLLAND",
            "state": "CT",
            "postal_code": "060843568",
            "telephone_number": "860-870-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEBOUT",
        "first_name": "DANA",
        "middle_name": "MARIE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-10",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "004894",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "9516",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANA",
            "last_name": "ANDREOLI",
            "middle_name": "MARIE",
            "credential": "CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sports Medicine and Orthopedic Surgery
• Swift Optometry Care PC
• Thrive and Dream Psychotherapy, LLC
• Through the Rain Counseling PLLC
• Tic, LLC
• Tolland Board of Education
• Tolland County Pediatrics & Adolescent Medicine, LLC
• Tolland Dental Associates LLC
• Tolland Eye Care LLC
• Tolland Family Chiropractic

• Speech-Language Pathologist in Tolland, CT
• Providers in Tolland, CT by specialty
• Speech-Language Pathologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.