Active NPI
Deborah Tedrick
- Professional Counselor
- Lincoln, IL
National Provider Identifier
1891962163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.003612
- Practice address
- 1700 N Jefferson St
Lincoln, IL 62656-1047 - Phone
- (217) 671-7225
- NPI assigned
- May 14, 2008
- Last updated
- May 14, 2008
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.003612 | IL | Primary |
Addresses
Primary practice location
1700 N Jefferson St
Lincoln, IL 62656-1047
Mailing address
1700 N Jefferson St
Lincoln, IL 62656-1047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.003612 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1891962163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 N JEFFERSON ST",
"city": "LINCOLN",
"state": "IL",
"postal_code": "626561047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 N JEFFERSON ST",
"city": "LINCOLN",
"state": "IL",
"postal_code": "626561047",
"telephone_number": "217-671-7225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEDRICK",
"first_name": "DEBORAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-14",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.003612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln, IL
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- Heidi Lynn Thorndyke
- Nichole Tinker
- Kristina Tipton
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.