Active NPI
Tiffany P Johnston, SLP
- Speech-Language Pathologist
- Presque Isle, ME
National Provider Identifier
1881880086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- ST1737
- Practice address
- 79 Blake St
Presque Isle, ME 04769-2474 - Phone
- (207) 764-4101
- NPI assigned
- Sep 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | ST1737 | ME | Primary |
Addresses
Primary practice location
79 Blake St
Presque Isle, ME 04769-2474
Mailing address
PO Box 308
Presque Isle, ME 04769-0308
Phone (207) 764-4498
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 432291999 | Medicaid | ME |
Other names 1
- Miss Tiffany P Lundeen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ST1737 | ME | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Maine Speech Language Pathology Services, Inc. | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Speech-Language Pathologist
- Presque Isle, ME
- NPI 1801934534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588809600000",
"number": "1881880086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 308",
"city": "PRESQUE ISLE",
"state": "ME",
"postal_code": "047690308",
"telephone_number": "207-764-4498",
"fax_number": "207-764-1912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 BLAKE ST",
"city": "PRESQUE ISLE",
"state": "ME",
"postal_code": "047692474",
"telephone_number": "207-764-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "TIFFANY",
"middle_name": "P",
"name_prefix": "Ms.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-20",
"last_updated": "2020-05-07",
"certification_date": "2020-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ME",
"license": "ST1737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "432291999",
"state": "ME"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "LUNDEEN",
"middle_name": "P",
"prefix": "MISS",
"credential": "SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Presque Isle, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; 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.