Maribeth Detmer, SLP
Individual provider Active NPI Speech-Language Pathologist · Breese, IL
NPI 1124156716 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124156716
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 1665 N 4TH St
Breese, IL 62230-1791 - Phone
- (618) 526-8830
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.002357 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | IL | Yes |
Addresses
Primary practice location
1665 N 4TH St
Breese, IL 62230-1791
Mailing address
828 Vossclare Dr
Breese, IL 62230-1074
Phone (618) 526-4038
Other providers in Breese, IL
- Clinton M. Smith DC PC
- Community Link, Inc.
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- Coping 4 Kids
- Kaci Cruthis
- Christina R Diesen
- Anne Doll-Pollard
- Douglas a Kruse MD LLC
- Thomas B Doyle
- Timothy H Droege
All providers in Breese, 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 Jul 8, 2007. 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.