Active NPI
Mary Theresa Vandiver
- Speech-Language Pathologist
- Heyworth, IL
National Provider Identifier
1063928430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.006321
- Practice address
- 100 S Joselyn St
Heyworth, IL 61745-9191 - Phone
- (309) 473-2822
- NPI assigned
- Dec 21, 2017
- 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 | 146.006321 | IL | Primary |
Addresses
Primary practice location
100 S Joselyn St
Heyworth, IL 61745-9191
Mailing address
100 S Joselyn St
Heyworth, IL 61745-9191
Phone (309) 473-2822
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
| License | State | Type | Specialty |
|---|---|---|---|
| 146.006321 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1063928430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S JOSELYN ST",
"city": "HEYWORTH",
"state": "IL",
"postal_code": "617459191",
"telephone_number": "309-473-2822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S JOSELYN ST",
"city": "HEYWORTH",
"state": "IL",
"postal_code": "617459191",
"telephone_number": "309-473-2822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDIVER",
"first_name": "MARY",
"middle_name": "THERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-21",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.006321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Heyworth, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.