Individual provider Active NPI

Katie Rybak Brennan, MS, CCC-SLP

  • Speech-Language Pathologist
  • Omaha, NE
National Provider Identifier
1104971175
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1438 Issued in NE
Practice address
425 N 30TH St
Omaha, NE 68131-2100
Phone
(402) 452-5043
Fax
(402) 452-5028
NPI assigned
Jan 23, 2007
Last updated
Jan 18, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X LL00004448 WA
Speech-Language Pathologist 235Z00000X 1438 NE Primary

Addresses

Primary practice location

425 N 30TH St
Omaha, NE 68131-2100

Mailing address

425 N 30TH St
Omaha, NE 68131-2100
Phone (206) 452-5043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120109000074 NE Practitioner - Qualified Speech Language Pathologist 3274709514 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1438NEMDChiropractor
LL00004448WAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Nebraska Board of Regents Current Accepting new patients
University of Nebraska Board of Regents CurrentSince Aug 1, 2015 Accepting new patients
University of Nebraska Board of Regents Speech-Language Pathologist CurrentSince Aug 1, 2015 Accepting new patients
ENT Services PC Speech-Language Pathologist Past Accepting new patients

Locations

4075 E Campus Loop S
Lincoln, NE 68583
Phone (402) 472-2068

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295308800000",
    "number": "1104971175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N 30TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312100",
            "telephone_number": "206-452-5043",
            "fax_number": "402-452-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N 30TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312100",
            "telephone_number": "402-452-5043",
            "fax_number": "402-452-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "KATIE",
        "middle_name": "RYBAK",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2011-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00004448",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NE",
            "license": "1438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.