Active NPI
Alexanne Kennedy Conklin, MS.CCC/SLP
- Speech-Language Pathologist
- Mountain Top, PA
National Provider Identifier
1053674234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL-002762-L
- Practice address
- 185 South Mountain Blvd
Mountain Top, PA 18707 - Phone
- (570) 474-6377
- Fax
- (570) 474-2109
- NPI assigned
- Jun 21, 2012
- Last updated
- Jun 21, 2012
- 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 | SL-002762-L | PA | Primary |
Addresses
Primary practice location
185 South Mountain Blvd
Mountain Top, PA 18707
Mailing address
PO Box 240
8796 Route 219
Brockway, PA 15824
Phone (814) 265-7874
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL-002762-L | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1053674234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 240",
"address_2": "8796 ROUTE 219",
"city": "BROCKWAY",
"state": "PA",
"postal_code": "15824",
"telephone_number": "814-265-7874",
"fax_number": "814-265-2082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "185 SOUTH MOUNTAIN BLVD",
"city": "MOUNTAIN TOP",
"state": "PA",
"postal_code": "18707",
"telephone_number": "570-474-6377",
"fax_number": "570-474-2109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "ALEXANNE",
"middle_name": "KENNEDY",
"name_prefix": "Ms.",
"credential": "MS.CCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-21",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL-002762-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Top, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.