Nicki Jo Theodoridis, M.ED.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

996 Issued in OK

Practice address

715 Glenridge Dr
Edmond, OK 73013-1824

Phone

(816) 753-5459

Fax

(816) 753-5119

NPI assigned

Aug 10, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1932653789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 GLENRIDGE DR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730131824",
            "telephone_number": "816-753-5459",
            "fax_number": "816-753-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 GLENRIDGE DR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730131824",
            "telephone_number": "816-753-5459",
            "fax_number": "816-753-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORIDIS",
        "first_name": "NICKI",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "M.ED.,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-10",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2016009648",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "996",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KS",
            "license": "3903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Edmond, OK
• Providers in Edmond, OK by specialty
• Speech-Language Pathologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; 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.