Active NPI
Kelli Brooke Marshall, MS, CCC-SLP
- Speech-Language Pathologist
- Oklahoma City, OK
National Provider Identifier
1083679658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3036
- Practice address
- 5500 N Western Ave
Suite 153
Oklahoma City, OK 73118-4019 - Phone
- (405) 286-3749
- Fax
- (866) 435-3297
- NPI assigned
- Apr 18, 2006
- 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 | 3036 | OK | Primary |
Addresses
Primary practice location
5500 N Western Ave
Suite 153
Oklahoma City, OK 73118-4019
Mailing address
2612 SE 39TH St
Moore, OK 73160-0642
Phone (405) 378-2929
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200063320B | Medicaid | OK |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3036 | OK | MD | Obesity and Weight Management Nutrition Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Today'S Therapy Solutions | 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 and National Provider Directory roles.
-
- Speech-Language Pathologist
- Moore, OK
- NPI 1558408450
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303084800000",
"number": "1083679658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2612 SE 39TH ST",
"city": "MOORE",
"state": "OK",
"postal_code": "731600642",
"telephone_number": "405-378-2929",
"fax_number": "866-435-3297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 N WESTERN AVE",
"address_2": "SUITE 153",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731184019",
"telephone_number": "405-286-3749",
"fax_number": "866-435-3297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "KELLI",
"middle_name": "BROOKE",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-18",
"last_updated": "2011-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OK",
"license": "3036",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200063320B",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.