Active NPI
Angella Brickner Lally, MA CCC-SLP
- Speech-Language Pathologist
- La Grange, IL
National Provider Identifier
1023215282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146006925
- Practice address
- 505 S Brainard Ave
La Grange, IL 60525-6107 - Phone
- (773) 860-4826
- NPI assigned
- Jun 29, 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 | 146006925 | IL | Primary |
Addresses
Primary practice location
505 S Brainard Ave
La Grange, IL 60525-6107
Mailing address
505 S Brainard Ave
La Grange, IL 60525-6107
Phone (773) 860-4826
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
| License | State | Type | Specialty |
|---|---|---|---|
| 146006925 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249862400000",
"number": "1023215282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S BRAINARD AVE",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605256107",
"telephone_number": "773-860-4826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S BRAINARD AVE",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605256107",
"telephone_number": "773-860-4826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LALLY",
"first_name": "ANGELLA",
"middle_name": "BRICKNER",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-29",
"last_updated": "2009-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146006925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.