Lisa M Kubelka

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.005286 Issued in IL

Practice address

209 9TH St Ste 302
Rockford, IL 61104-2235

Phone

(779) 696-4400

NPI assigned

Sep 6, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Swedish American Pediatric Therapy Services

  • Early Intervention Provider Agency
  • Rockford, IL
  • NPI 1215108741
  NPD (past)
• Swedishamerican Hospital

  • Community/Retail Pharmacy
  • Rockford, IL
  • NPI 1306635982
  NPD (past)

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1083995955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 9TH ST STE 302",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042235",
            "telephone_number": "779-696-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBELKA",
        "first_name": "LISA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.005286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH-LANGUAGE PATHOLOGIST",
            "identifier": "146.005286",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon M Krueger, APN
• Jennie Rebecca Krull, PMHNP-BC
• Dana Kruse, RBT -17-34424
• Kathleen A Kruse
• Bianka Sara Ksiazek, DPM
• Tammy M Kucia, PA C
• Nicolaus J. Kuehn, MD
• Chadwick Kuehne
• Jolynn C Kuhl, PT
• Kayla Kuhn

• Speech-Language Pathologist in Rockford, IL
• Providers in Rockford, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; 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.