NPIMap

Individual provider Active NPI

Renee L Kelderhouse, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Mesa, AZ
National Provider Identifier
1194060632
Registry record updated Oct 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP8368 Issued in AZ
Practice address
733 N Longmore
Mesa, AZ 85201-4525
Phone
(480) 472-4900
NPI assigned
Dec 10, 2012
Last updated
Oct 2, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SZ 5879 FL
Speech-Language Pathologist 235Z00000X SLP8368 AZ Primary

Addresses

Primary practice location

733 N Longmore
Mesa, AZ 85201-4525

Mailing address

16428 E Kingstree Blvd
Fountain Hills, AZ 85268-5440

Other names 1

  • Ms. Renee L Spragg Former name

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SLP8368AZMDSpeech-Language Pathologist
SZ 5879FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Pet, LLC Past Accepting new patients
Student Therapies and Resource Services Speech-Language Pathologist Past Accepting new patients
Solace Pediatric Healthcare Therapy Services Az, Inc. Speech-Language Pathologist PastSince Jan 1, 1995 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1194060632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16428 E KINGSTREE BLVD",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852685440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 N LONGMORE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852014525",
            "telephone_number": "480-472-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELDERHOUSE",
        "first_name": "RENEE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-10",
        "last_updated": "2015-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ 5879",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP8368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "SPRAGG",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.