Active NPI
Tara Kolmodin
- Speech-Language Pathologist
- Wheaton, IL
National Provider Identifier
1043984594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 1725 S Naperville Rd Ste 110
Wheaton, IL 60189-5855 - Phone
- (630) 793-8404
- NPI assigned
- Aug 6, 2021
- Last updated
- Aug 6, 2021
- 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 | IL | Primary |
Addresses
Primary practice location
1725 S Naperville Rd Ste 110
Wheaton, IL 60189-5855
Mailing address
1725 S Naperville Rd Ste 110
Wheaton, IL 60189-5855
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Childrens Therapy | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1043984594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 S NAPERVILLE RD STE 110",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 S NAPERVILLE RD STE 110",
"city": "WHEATON",
"state": "IL",
"postal_code": "601895855",
"telephone_number": "630-793-8404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLMODIN",
"first_name": "TARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-06",
"last_updated": "2021-08-06",
"certification_date": "2021-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.