Active NPI
Emily Revelle
- Speech-Language Pathologist
- Lebanon, MO
National Provider Identifier
1245749753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2009024740
- Practice address
- 24699 Donald Ave
Lebanon, MO 65536-4950 - Phone
- (573) 576-7549
- NPI assigned
- Sep 27, 2017
- Last updated
- Sep 27, 2017
- 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 | 2009024740 | MO | Primary |
Addresses
Primary practice location
24699 Donald Ave
Lebanon, MO 65536-4950
Mailing address
24699 Donald Ave
Lebanon, MO 65536-4950
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 |
|---|---|---|---|
| 2009024740 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506470400000",
"number": "1245749753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24699 DONALD AVE",
"city": "LEBANON",
"state": "MO",
"postal_code": "655364950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24699 DONALD AVE",
"city": "LEBANON",
"state": "MO",
"postal_code": "655364950",
"telephone_number": "573-576-7549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELLE",
"first_name": "EMILY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-27",
"last_updated": "2017-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2009024740",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, MO
- Candice Loriel Reeves, PHYSICAL THERAPIST
- Regional Care of Lebanon North, LLC (Christian Health and Rehabilitation of Lebanon North)
- Regional Care of Lebanon South, LLC (Christian Health and Rehabilitation of Lebanon South)
- Regional Services (Cox Medical Associates of Lebanon)
- Renal Care Group of the Ozarks, LLC (Renal Care Group Lebanon)
- Kelly Dan Rhoades, PLPC, MA
- Suzette Richmond, LPC
- John Kent Richter, DDS
- Kelly Riechers, CRNA
- Jodie C Ritchel, MASSAGE THERAPIST
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.