Active NPI
Johanna Nebel, M.S. CCC-SLP
- Speech-Language Pathologist
- Alsip, IL
National Provider Identifier
1174171029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.004965
- Practice address
- 11751 S Lawler Ave
Alsip, IL 60803-4931 - Phone
- (708) 371-5351
- NPI assigned
- Sep 3, 2019
- Last updated
- Sep 3, 2019
- 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 | 242.004965 | IL | Primary |
Addresses
Primary practice location
11751 S Lawler Ave
Alsip, IL 60803-4931
Mailing address
16550 Grants TRL
Orland Park, IL 60467-8724
Phone (708) 612-2481
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14338467 | Other | ASHA | |
| 242.004965 | Other | IL | LICENSED SPEECH LANGUAGE PATHOLOGY TEMPORARY |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242.004965 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567468800000",
"number": "1174171029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16550 GRANTS TRL",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604678724",
"telephone_number": "708-612-2481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11751 S LAWLER AVE",
"city": "ALSIP",
"state": "IL",
"postal_code": "608034931",
"telephone_number": "708-371-5351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEBEL",
"first_name": "JOHANNA",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-03",
"last_updated": "2019-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.004965",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA",
"identifier": "14338467",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED SPEECH LANGUAGE PATHOLOGY TEMPORARY",
"identifier": "242.004965",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alsip, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.