Individual provider Active NPI

Rachel N Van Vliet, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Tustin, CA
National Provider Identifier
1962000893
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
30656 Issued in CA
Practice address
3002 Dow Ave Ste 114
Tustin, CA 92780-7247
Phone
(714) 731-4668
NPI assigned
Oct 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 30656 CA Primary

Addresses

Primary practice location

3002 Dow Ave Ste 114
Tustin, CA 92780-7247

Mailing address

1401 Brighton St
La Habra, CA 90631-3201
Phone (562) 448-8217

Other practice location 1

11019 Valley Home Ave
Whittier, CA 90603-3042
Phone (562) 943-0211

Other practice location 2

1401 Brighton St
LA Habra, CA 90631-3201
Phone (562) 448-8217

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 Science

State licenses

LicenseStateTypeSpecialty
30656CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lowell Joint School District Past Accepting new patients
Centra Pediatric Therapy Speech-Language Pathologist PastSince Oct 19, 2020 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1962000893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 BRIGHTON ST",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906313201",
            "telephone_number": "562-448-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3002 DOW AVE STE 114",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807247",
            "telephone_number": "714-731-4668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11019 Valley Home Ave",
            "address_purpose": "LOCATION",
            "city": "Whittier",
            "state": "CA",
            "postal_code": "906033042",
            "country_code": "US",
            "telephone_number": "562-943-0211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Brighton St",
            "address_purpose": "LOCATION",
            "city": "LA Habra",
            "state": "CA",
            "postal_code": "906313201",
            "country_code": "US",
            "telephone_number": "562-448-8217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN VLIET",
        "first_name": "RACHEL",
        "middle_name": "N",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "30656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.