Abc Pediatric Therapy, LLC
Organization Active NPI Speech-Language Pathologist · O Fallon, IL
NPI 1124044698 · NPPES record last updated Jun 17, 2011
Key facts
- NPI
- 1124044698
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Legal business name
- ABC PEDIATRIC THERAPY, LLC
- Practice address
- 634 N Main St
Suite 3
O Fallon, IL 62269-3746 - Phone
- (618) 632-4222
- Fax
- (618) 632-4658
- NPI assigned
- Jul 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy L. Bruce, MS CCC-SLP
- Title
- Owner
- Phone
- (618) 632-4222
Practitioners 35
-
Jamie Ann Burch, M.A. CF-SLP
-
Abby Jo Eccles, DPT
-
Alyssa K Hill, DPT
-
Jamie Lee Kilquist, PTA
-
Melissa Lisk, M.A., CF-SLP/L
-
Zachary Medema, M.S.
-
Madeline Moll, CF-SLP
-
Amanda J Newkirk, MS-CCC/SLP
-
Candace Lynn Noonan, MS SLP
-
Merinda Passmore, MS CCC-SLP
-
Kyla Raftery, MA, CF-SLP
-
Brooke Nicole Renspurger, MS, CF- SLP
-
Andrea M Russell, MS, CCC-SLP
-
Margret Anne Schierberl, MA, CCC-SLP/L
National Provider Directory
Locations
634 N Main St
Ste 3
O Fallon, IL 62269
Phone (618) 315-9601
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X | Yes |
Addresses
Primary practice location
634 N Main St
Suite 3
O Fallon, IL 62269-3746
Mailing address
634 N Main St
Suite 3
O Fallon, IL 62269-3746
Phone (618) 632-4222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08232136 | Other | IL | BLUE CROSS BLUE SHIELD |
| 348620164001 | Medicaid | IL |
Other providers in O Fallon, IL
- Alexis Aaron
- Megan Abrahamian
- Ramontay J'Von Demeterius Abram
- Acorn Health of Illinois, LLC
- Adaptive Equipment Corner, LLC
- Adoration Home Health of Illinois, LLC
All providers in O Fallon, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.