Tina Fausett, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7620 Issued in MN

Practice address

11455 Viking Dr
Suite 300
Eden Prairie, MN 55344-7251

Phone

(952) 993-2498

Fax

(952) 993-2505

NPI assigned

Jul 1, 2009

Last updated

Jul 1, 2009By the provider in NPPES

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

Other names 1

• Tina Pirkl Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246406400000",
    "number": "1871721514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11455 VIKING DR",
            "address_2": "SUITE 300",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11455 VIKING DR",
            "address_2": "SUITE 300",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447251",
            "telephone_number": "952-993-2498",
            "fax_number": "952-993-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUSETT",
        "first_name": "TINA",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2009-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "7620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "PIRKL",
            "credential": "MS, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Courteney Felten
• Fernanda Matsuda, LLC

• Speech-Language Pathologist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.