Individual provider Active NPI

Kristin H. McKay, SLP

  • Speech-Language Pathologist
  • Danbury, CT
National Provider Identifier
1174774483
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
002069 Issued in CT
Practice address
105 Newtown Road a
Suite #5
Danbury, CT 06810
Phone
(203) 739-0765
Fax
(203) 739-0792
NPI assigned
Oct 6, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 002069 CT Primary

Addresses

Primary practice location

105 Newtown Road a
Suite #5
Danbury, CT 06810

Mailing address

1377 Motor Pkwy
Ste 307
Islandia, NY 11749-5258
Phone (203) 740-0020

Other practice location 1

33 Church Hill Rd
Newtown, CT 06470-1637
Phone (475) 828-0932

Other identifiers 1

IdentifierTypeStateIssuer
1174774483MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210609003513 CT Practitioner - Qualified Speech Language Pathologist 3577963701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Connecticut IncGroup PAC ID 8325203649, 71 clinicians

Practice addresses (Care Compare)

3 Federal Rd
Brookfield, CT 06804-2505
Phone (203) 456-1010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2069CTMDOccupational Therapy Assistant
002069CTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Connecticut, Inc. Speech-Language Pathologist CurrentSince Jun 11, 2021 Accepting new patients
Carlson Therapy Network, PC Past Accepting new patients
Carlson Therapy Network Past Accepting new patients

Locations

3 Federal Rd
Brookfield, CT 06804
Phone (203) 456-1010

33 Church Hill Rd
Newtown, CT 06470
Phone (203) 426-1818

101 N Plains Rd
Wallingford, CT 06492
Phone (203) 265-0018

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1223251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1174774483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY",
            "address_2": "STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "203-740-0020",
            "fax_number": "203-775-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 NEWTOWN ROAD A",
            "address_2": "SUITE #5",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "06810",
            "telephone_number": "203-739-0765",
            "fax_number": "203-739-0792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33 Church Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Newtown",
            "state": "CT",
            "postal_code": "064701637",
            "country_code": "US",
            "telephone_number": "475-828-0932",
            "fax_number": "475-209-8054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKAY",
        "first_name": "KRISTIN",
        "middle_name": "H.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-06",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "002069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174774483",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.