Bloomington-Normal Speech Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

BLOOMINGTON-NORMAL SPEECH THERAPY LLC

Practice address

2416 E Washington St Ste C5
Bloomington, IL 61704-1629

Phone

(309) 830-5925

NPI assigned

Dec 9, 2020

Organization subpart

No

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

Authorized official

Name

Basha M Ontiveros, M.S., CCC-SLPNPI 1629083423

Title

Owner

Phone

(309) 830-5925

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Basha Ontiveros, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Bloomington, IL
  • NPI 1629083423
  NPD Authorized official
• Julia M Current

  • Speech-Language Pathologist
  • Bloomington, IL
  • NPI 1336805308

  Single Specialty

  NPD

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1336745892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 E WASHINGTON ST STE C5",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041629",
            "telephone_number": "309-830-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 E WASHINGTON ST STE C5",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041629",
            "telephone_number": "309-830-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON-NORMAL SPEECH THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "ONTIVEROS",
        "authorized_official_first_name": "BASHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-830-5925",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) - PRIOR NPI#",
            "identifier": "1629083423",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.