Active NPI
Andrea Peabody
- Speech-Language Pathologist
- Manchester, MO
National Provider Identifier
1336850239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 20220381558
- Practice address
- 14733 Clayton Rd
Manchester, MO 63011-2660 - Phone
- (314) 339-7732
- NPI assigned
- Dec 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 20220381558 | MO | Primary |
Addresses
Primary practice location
14733 Clayton Rd
Manchester, MO 63011-2660
Mailing address
5363 Odell St
Saint Louis, MO 63139-1414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2022038158 | Medicaid | MO |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://members.centralreach.com/#account | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20220381558 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Autism and Behavioral Spectrum LLC | Past | Accepting new patients |
Organizations & group practices 1
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": "1670803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670803200000",
"number": "1336850239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5363 ODELL ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631391414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14733 CLAYTON RD",
"city": "MANCHESTER",
"state": "MO",
"postal_code": "630112660",
"telephone_number": "314-339-7732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEABODY",
"first_name": "ANDREA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-12",
"last_updated": "2022-12-12",
"certification_date": "2022-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "20220381558",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2022038158",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://members.centralreach.com/#account",
"affiliation": "N",
"endpointDescription": "https://members.centralreach.com/#account",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "14733 Clayton Rd",
"city": "Manchester",
"state": "MO",
"country_code": "US",
"postal_code": "630112660",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Manchester, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.