Tessa Dunivan

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2018034573 Issued in MO

Practice address

801 Brim St
Desloge, MO 63601-3441

Phone

(573) 431-0223

NPI assigned

Jun 18, 2019

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1861052219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3171 HIGHWAY H",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636407049",
            "telephone_number": "573-915-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BRIM ST",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636013441",
            "telephone_number": "573-431-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNIVAN",
        "first_name": "TESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2018034573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "ta30.stu@mineralarea.edu",
            "affiliation": "N",
            "address_1": "801 Brim St",
            "city": "Desloge",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636013441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "NationalHealthCareCorporation",
            "affiliation": "N",
            "address_1": "801 Brim St",
            "city": "Desloge",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636013441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Madison Renee Davis, COTA/L
• Desloge Chiropractic Health Center, LLC
• Desloge Vision Center Inc
• Brett Dickinson, M.D.
• Hannah Jean Mendez Dominguez
• Nicholas Joseph Dupont, PHARMD
• Eastern Missouri General Services Inc
• Michael Christopher Essmyer, D.C.
• Stephen M Forsythe, DO
• Rebecca S Francis, OTR/L

• Speech-Language Pathologist in Desloge, MO
• Providers in Desloge, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; 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.