Kelsey Sullivan, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146011094 Issued in IL

Practice address

200 S Station Rd
Glen Carbon, IL 62034-2777

Phone

(618) 288-5014

NPI assigned

Apr 10, 2012

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

Other names 1

• Kelsey Hubert Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Progress to Success Speech Therapy PLLC

  • Speech-Language Pathologist
  • Smithton, IL
  • NPI 1942809231
  Medicare reassignment NPD Authorized official
• Preferred Podiatry Group PC

  • Podiatrist
  • Oak Harbor, WA
  • NPI 1720037138
  NPD (past)

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1346506789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 W DIVISION ST",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626831",
            "telephone_number": "618-719-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S STATION RD",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342777",
            "telephone_number": "618-288-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELSEY",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146011094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "HUBERT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew John Strazewski, D.C.
• David Harold Strickfaden, ATCL
• Marlo Ann Stuart, OTR/L
• Melissa Eileen Suermann, COTA/L
• Andrea Lee Sullivan, DMD
• Superior Chiropractic & Rehab
• Laura Szczepan
• T & C Ultrasound LLC
• Riley Tanner, LPC, MA
• TCWC Glen Carbon, LLC

• Speech-Language Pathologist in Glen Carbon, IL
• Providers in Glen Carbon, 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 May 2, 2022; 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.