NPIMap

Organization Active NPI

Laboratory of Speech and Language Disorders, Inc.

  • Speech-Language Pathologist
  • Omaha, NE
National Provider Identifier
1124199419
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
510 Issued in NE
Legal business name
LABORATORY OF SPEECH AND LANGUAGE DISORDERS, INC.
Practice address
4239 Farnam St
Suite 509
Omaha, NE 68131-2868
Phone
(402) 551-7338
Fax
(402) 551-3072
NPI assigned
Nov 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Patricia J. Gill, M.S., CCCNPI 1821144874
Title
Speech Pathologist , Owner
Phone
(402) 551-7338

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 510 NE Primary

Addresses

Primary practice location

4239 Farnam St
Suite 509
Omaha, NE 68131-2868

Mailing address

4239 Farnam St
Suite 509
Omaha, NE 68131-2868
Phone (402) 551-7338

Other identifiers 1

IdentifierTypeStateIssuer
08782OtherNEBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170602000504 NE Part B Supplier - Clinic/Group Practice 2668749243 Receives reassigned benefits from 1 practitioner
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Locations

4239 Farnam St
Ste 509
Omaha, NE 68131
Phone (402) 551-7338

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124199419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4239 FARNAM ST",
            "address_2": "SUITE 509",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312868",
            "telephone_number": "402-551-7338",
            "fax_number": "402-551-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4239 FARNAM ST",
            "address_2": "SUITE 509",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312868",
            "telephone_number": "402-551-7338",
            "fax_number": "402-551-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY OF SPEECH AND LANGUAGE DISORDERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SPEECH PATHOLOGIST , OWNER",
        "authorized_official_telephone_number": "402-551-7338",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S., CCC"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NE",
            "license": "510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08782",
            "state": "NE"
        }
    ],
    "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 Aug 22, 2020; 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.