Individual provider Active NPI

Erin Siobhan Tully-Clinard, MA, CCC-SLP

  • Speech-Language Pathologist
  • Tacoma, WA
National Provider Identifier
1922026905
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
LL00004323 Issued in WA
Practice address
1220 Division Ave
Tacoma, WA 98403-1321
Phone
(253) 403-4437
Fax
(253) 627-5004
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 0000003121 TN
Speech-Language Pathologist 235Z00000X LL00004323 WA Primary

Addresses

Primary practice location

1220 Division Ave
Tacoma, WA 98403-1321

Mailing address

31500 33Rd PL SW Apt Q103
Federal Way, WA 98023-5923
Phone (253) 508-9394

Other identifiers 1

IdentifierTypeStateIssuer
4106728OtherTNBCBS PROVIDER ID NUMBER

Other names 1

  • Ms. Erin Siobhan Tully Former name

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
0000003121TNMDSpeech-Language Pathologist
LL00004323WAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1922026905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31500 33RD PL SW APT Q103",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980235923",
            "telephone_number": "253-508-9394",
            "fax_number": "253-627-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 DIVISION AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984031321",
            "telephone_number": "253-403-4437",
            "fax_number": "253-627-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY-CLINARD",
        "first_name": "ERIN",
        "middle_name": "SIOBHAN",
        "name_prefix": "Mrs.",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "0000003121",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00004323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID NUMBER",
            "identifier": "4106728",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "TULLY",
            "middle_name": "SIOBHAN",
            "prefix": "MS.",
            "credential": "MA, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.