Individual provider Active NPI

Marissa Kaitlyn Kershner

  • Speech-Language Pathologist
  • Champaign, IL
National Provider Identifier
1093667180
Registry record updated Feb 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
242008281 Issued in IL
Practice address
701 Devonshire Dr Ste D1
Champaign, IL 61820-7356
Phone
(217) 922-0090
NPI assigned
Feb 11, 2026
Last updated
Feb 11, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 242008281 IL Primary

Addresses

Primary practice location

701 Devonshire Dr Ste D1
Champaign, IL 61820-7356

Mailing address

915 Marietta Dr
Mahomet, IL 61853-9105
Phone (815) 742-2213

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

LicenseStateTypeSpecialty
242008281ILMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1770768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770768000000",
    "number": "1093667180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 MARIETTA DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618539105",
            "telephone_number": "815-742-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DEVONSHIRE DR STE D1",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618207356",
            "telephone_number": "217-922-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSHNER",
        "first_name": "MARISSA",
        "middle_name": "KAITLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-11",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242008281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2026; 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.