Active NPI
Nancy Sansom Rathburn, MACCC-SLP
- Speech-Language Pathologist
- Fort Wayne, IN
National Provider Identifier
1104126895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22001327A
- Practice address
- 3320 E State Blvd
Fort Wayne, IN 46805-5601 - Phone
- (260) 484-3120
- Fax
- (260) 969-0104
- NPI assigned
- Oct 27, 2010
- 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 | 22001327A | IN | Primary |
Addresses
Primary practice location
3320 E State Blvd
Fort Wayne, IN 46805-5601
Mailing address
3320 E State Blvd
Fort Wayne, IN 46805-5601
Phone (260) 484-3120
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 |
|---|---|---|---|
| 22001327A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288137600000",
"number": "1104126895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3320 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055601",
"telephone_number": "260-484-3120",
"fax_number": "260-969-0104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055601",
"telephone_number": "260-484-3120",
"fax_number": "260-969-0104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RATHBURN",
"first_name": "NANCY",
"middle_name": "SANSOM",
"credential": "MACCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-27",
"last_updated": "2010-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22001327A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.