Active NPI
Marilyn Goertel-Breen, SLP
- Speech-Language Pathologist
- Evansville, IN
National Provider Identifier
1063875805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 827
- Practice address
- 12251 Highway 41 N
Suite a
Evansville, IN 47725-7014 - Phone
- (812) 868-1224
- Fax
- (866) 715-9733
- NPI assigned
- Mar 30, 2016
- 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 | 827 | IA | Primary |
Addresses
Primary practice location
12251 Highway 41 N
Suite a
Evansville, IN 47725-7014
Mailing address
14440 N 51St Ave W
Mingo, IA 50168-8544
Phone (515) 577-8847
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 |
|---|---|---|---|
| 827 | IA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459296000000",
"number": "1063875805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14440 N 51ST AVE W",
"city": "MINGO",
"state": "IA",
"postal_code": "501688544",
"telephone_number": "515-577-8847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12251 HIGHWAY 41 N",
"address_2": "SUITE A",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477257014",
"telephone_number": "812-868-1224",
"fax_number": "866-715-9733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOERTEL-BREEN",
"first_name": "MARILYN",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-30",
"last_updated": "2016-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IA",
"license": "827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.