Active NPI
Dana Reilly, SLP
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1033249305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1818
- Practice address
- 9620 Giddings Ave NE
Albuquerque, NM 87109-6413 - Phone
- (505) 856-0284
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 1818 | NM | Primary |
Addresses
Primary practice location
9620 Giddings Ave NE
Albuquerque, NM 87109-6413
Mailing address
9620 Giddings Ave NE
Albuquerque, NM 87109-6413
Phone (505) 856-0284
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D0226 | Medicaid | NM | |
| R 6209 | Medicaid | NM |
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 |
|---|---|---|---|
| 1818 | NM | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icon Innovations LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Speech-Language Pathologist
- Albuquerque, NM
- NPI 1760540512
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1033249305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9620 GIDDINGS AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871096413",
"telephone_number": "505-856-0284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9620 GIDDINGS AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871096413",
"telephone_number": "505-856-0284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "DANA",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "1818",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D0226",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "R 6209",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.