Chancy Nicole Rodeghero
Individual provider Active NPI Speech-Language Pathologist · Quincy, IL
NPI 1265615520 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1265615520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146012060 (IL)
- Practice address
- 1416 Maine St
Quincy, IL 62301-4261 - Phone
- (217) 223-8700
- NPI assigned
- Dec 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200210000078 | IL | Practitioner - Qualified Speech Language Pathologist | 6305083049 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146012060 | IL | MD | Speech-Language Pathologist |
| 2006015397 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quincy Physicians & Surgeons Clinic, PLLC | Current |
Accepting new patients | |
| Quincy Physicians & Surgeons Clinic, PLLC | Current | Accepting new patients | |
| Access Physical Therapy | Current |
Accepting new patients | |
| Quincy Physicians & Surgeons Clinic, PLLC | Current |
Accepting new patients | |
| Hannibal School District #60 | Past | Accepting new patients |
Locations
1025 Maine St
Quincy, IL 62301
Phone 21722265503163
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2006015397 | MO | |
| Speech-Language Pathologist | 235Z00000X | 146012060 | IL | Yes |
Addresses
Primary practice location
1416 Maine St
Quincy, IL 62301-4261
Mailing address
10960 Scott PL
Hannibal, MO 63401-7387
Phone (573) 822-5732
Other practice location 1
4650 McMasters Ave
Hannibal, MO 63401-2244
Phone (573) 221-1258
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 467618906 | Medicaid | MO |
Other providers in Quincy, IL
- Wade Roberts
- Shari W Robesky
- Michelle Beth Robison
- Yvonne Robison
- Sara Rodeffer
- Sarah Jean Rommesmo
- Cynthia M Root
- Abigail Rose
- Angie Rose
- Teresa Gail Rose
All providers in Quincy, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.