Brandi Michelle Wallgren, M.A, CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2016026106 Issued in MO

Practice address

100 S Garrison Ave
Saint Louis, MO 63103-2538

Phone

(314) 340-5902

NPI assigned

Aug 29, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Haislup

  • Speech-Language Pathologist
  • Saint Louis, MO
  • NPI 1518162791
  NPD (past)

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472428800000",
    "number": "1275089336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 BELLA VISTA DR",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637557850",
            "telephone_number": "573-803-7434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S GARRISON AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032538",
            "telephone_number": "314-340-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLGREN",
        "first_name": "BRANDI",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "M.A, CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-29",
        "last_updated": "2016-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2016026106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karl Christian Wallenkampf, MD
• Shannon Waller Davis, CNM
• Debra Ann Waller-Lee, LCSW
• Kiersten Waller
• Natalie Waller
• Eileen Wallhermfechtel
• James Herman Wallhermfechtel, PH.D.
• Erin Renee Wallin, CRNA
• Joseph Walline, M.D.
• Jennifer Elizabeth Wallis, MSW

• Speech-Language Pathologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; 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.