Active NPI
Mildred Louise Pate, DT
- Developmental Therapist
- McLeansboro, IL
National Provider Identifier
1245415009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- MP14130298P
- Practice address
- RR 4 Box 222
MC Leansboro, IL 62859-9461 - Phone
- (618) 773-4541
- NPI assigned
- Dec 29, 2007
- Last updated
- Dec 29, 2007
- 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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | MP14130298P | IL | Primary |
Addresses
Primary practice location
RR 4 Box 222
MC Leansboro, IL 62859-9461
Mailing address
RR 4 Box 222
MC Leansboro, IL 62859-9461
Phone (618) 773-4541
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 |
|---|---|---|---|
| MP14130298P | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198886400000",
"number": "1245415009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 4 BOX 222",
"city": "MC LEANSBORO",
"state": "IL",
"postal_code": "628599461",
"telephone_number": "618-773-4541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "RR 4 BOX 222",
"city": "MC LEANSBORO",
"state": "IL",
"postal_code": "628599461",
"telephone_number": "618-773-4541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATE",
"first_name": "MILDRED",
"middle_name": "LOUISE",
"credential": "DT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-29",
"last_updated": "2007-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "MP14130298P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McLeansboro, IL
- Donald Eugene Mitchell, M.D.
- Christopher Moore, DO
- Lilly Lynn Mosby I, BEHAVIOR TECHNICIAN
- Kadhiresan Murugappan, MD SC
- Katelyn Nelson, FNP
- Petersen Health Operations, LLC (McLeansboro Rehabilitation & Health Care Center)
- Jared Pryer, LPC
- Rci WRS Inc
- Robert Brad Ringhofer, M.D.
- Evana Ruth Sandusky, CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.