Individual provider Active NPI

Courtney Klokkenga, M.S. CCC-SLP/L

  • Speech-Language Pathologist
  • Bloomington, IL
National Provider Identifier
1336480391
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146011182 Issued in IL
Practice address
1925 S Main St
Bloomington, IL 61704-7313
Phone
(309) 829-4348
Fax
(309) 827-4570
NPI assigned
Mar 14, 2013
Last updated
Aug 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 146011182 IL Primary

Addresses

Primary practice location

1925 S Main St
Bloomington, IL 61704-7313

Mailing address

1925 S Main St
Bloomington, IL 61704-7313

Other names 1

  • Courtney Bustle Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250214001248 IL Practitioner - Qualified Speech Language Pathologist 0143750539 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7108 Marine Rd
Edwardsville, IL 62025-4282
Phone (618) 706-9759

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
146011182ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
At Home by Enhance Therapies LLC Speech-Language Pathologist CurrentSince Jan 1, 2025 Accepting new patients
Empowerme Wellness Kansas City, LLC Speech-Language Pathologist CurrentSince Aug 5, 2025 Accepting new patients
Empowerme Wellness Kansas City, LLC CurrentSince Aug 5, 2025 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Aug 5, 2025 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Aug 5, 2025 Accepting new patients

Locations

1021 W E St
Belleville, IL 62220
Phone (618) 233-2095

4825 Evergreen Ct
Decatur, IL 62521
Phone (217) 864-4300

7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759

7358 N Lincoln Ave
Ste 160
Lincolnwood, IL 60712
Phone (847) 983-8750

1701 Evergreen Blvd
Normal, IL 61761
Phone (309) 451-9355

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

400 Route 70
Lakewood, NJ 08701
Phone (732) 802-7512

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1336480391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 S MAIN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 S MAIN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047313",
            "telephone_number": "309-829-4348",
            "fax_number": "309-827-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOKKENGA",
        "first_name": "COURTNEY",
        "credential": "M.S. CCC-SLP/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-14",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146011182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "BUSTLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.