Active NPI
Kathleen Brandell-Champagne, CCC-SLP
- Speech-Language Pathologist
- West Chazy, NY
National Provider Identifier
1164730776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 58010723
- Practice address
- 37 Eagle Way
West Chazy, NY 12992 - Phone
- (518) 563-8035
- NPI assigned
- Sep 16, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 58010723 | NY | Primary |
Addresses
Primary practice location
37 Eagle Way
West Chazy, NY 12992
Mailing address
126 Lighthouse Road
Plattsburgh, NY 12901
Phone (518) 569-5660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58010723 | Other | NY | NEW YORK STATE LICENSE NUMBER |
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 |
|---|---|---|---|
| 58010723 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620432000000",
"number": "1164730776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 LIGHTHOUSE ROAD",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-569-5660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 EAGLE WAY",
"city": "WEST CHAZY",
"state": "NY",
"postal_code": "12992",
"telephone_number": "518-563-8035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDELL-CHAMPAGNE",
"first_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-16",
"last_updated": "2021-05-08",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "58010723",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE LICENSE NUMBER",
"identifier": "58010723",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Chazy, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.