Individual provider Active NPI

Kristen Lee Grohne, SLP

  • Speech-Language Pathologist
  • Decatur, IL
National Provider Identifier
1053510040
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone
(217) 464-2415
Fax
(217) 464-1633
NPI assigned
Jul 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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 IL Primary

Addresses

Primary practice location

1800 E Lake Shore Dr
Decatur, IL 62521-3810

Mailing address

461 Timber Dr
Decatur, IL 62521-5516
Phone (217) 429-1041

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

LicenseStateTypeSpecialty
146006050ILMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1053510040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 TIMBER DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215516",
            "telephone_number": "217-429-1041",
            "fax_number": "217-464-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E LAKE SHORE DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213810",
            "telephone_number": "217-464-2415",
            "fax_number": "217-464-1633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROHNE",
        "first_name": "KRISTEN",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.