Active NPI
Elizabeth Ice
- Speech-Language Pathologist
- East Peoria, IL
National Provider Identifier
1235477472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146011415
- Practice address
- 112 Heatherview Dr
East Peoria, IL 61611-4889 - Phone
- (309) 360-0707
- NPI assigned
- Jan 23, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 146011415 | IL | Primary |
Addresses
Primary practice location
112 Heatherview Dr
East Peoria, IL 61611-4889
Mailing address
610 E Walnut St
Bloomington, IL 61701-3242
Phone (309) 363-8599
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 |
|---|---|---|---|
| 146011415 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358899200000",
"number": "1235477472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 E WALNUT ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013242",
"telephone_number": "309-363-8599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 HEATHERVIEW DR",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616114889",
"telephone_number": "309-360-0707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICE",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-23",
"last_updated": "2013-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146011415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.