Active NPI
Angelic Berry, M.ED, M.S.
- Speech-Language Pathologist
- Scott AFB, IL
National Provider Identifier
1033530845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.010486
- Practice address
- 4732 Patriots Dr
Scott AFB, IL 62225-1197 - Phone
- (618) 746-4738
- NPI assigned
- Dec 20, 2013
- Last updated
- Dec 20, 2013
- 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 | 146.010486 | IL | Primary |
Addresses
Primary practice location
4732 Patriots Dr
Scott AFB, IL 62225-1197
Mailing address
4732 Patriots Dr
Scott AFB, IL 62225-1197
Phone (618) 746-4738
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 934010 | Other | IL | ILLINOIS STATE BOARD OF EDUCATION |
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 Education, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.010486 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387497600000",
"number": "1033530845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4732 PATRIOTS DR",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622251197",
"telephone_number": "618-746-4738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4732 PATRIOTS DR",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622251197",
"telephone_number": "618-746-4738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "ANGELIC",
"name_prefix": "Mrs.",
"credential": "M.ED, M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-20",
"last_updated": "2013-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.010486",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS STATE BOARD OF EDUCATION",
"identifier": "934010",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scott AFB, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.