Avery Lynn Pack, M.S.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2018023350 Issued in MO

Practice address

2108 Main St
Lexington, MO 64067-1822

Phone

(660) 259-4448

NPI assigned

Aug 28, 2018

Last updated

Nov 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lexington School Dixt RV

  • Local Education Agency (LEA)
  • Lexington, MO
  • NPI 1275678823

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1306327101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 MAIN ST",
            "city": "LEXINGTON",
            "state": "MO",
            "postal_code": "640671822",
            "telephone_number": "660-259-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 MAIN ST",
            "city": "LEXINGTON",
            "state": "MO",
            "postal_code": "640671822",
            "telephone_number": "660-259-4448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2323A High School Dr",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "MO",
            "postal_code": "640671525",
            "country_code": "US",
            "telephone_number": "660-259-4369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACK",
        "first_name": "AVERY",
        "middle_name": "LYNN",
        "credential": "M.S.,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2018023350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Michael Morgan, DDS
• Stephanie Malyn Morris, LCSW, CRADC, ICADC
• Rylee Janae Moss
• Maria Jean Mulvey
• Julie Ann O'Donnell, LP
• Monika Patel
• Clinton Pickett, D.O.
• Lea Rich, D.D.S
• William David Rich, DDS
• Riverbend Heights Health & Rehabilitation LLC

• Speech-Language Pathologist in Lexington, MO
• Providers in Lexington, 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 Nov 25, 2019; 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.