Active NPI
Brooke E Keller, SLP
- Speech-Language Pathologist
- Grand Forks, ND
National Provider Identifier
1346545092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1142
- Practice address
- 1000 S Columbia Rd
Grand Forks, ND 58201-4032 - Phone
- (701) 780-5000
- NPI assigned
- Jan 11, 2011
- 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 | 1142 | ND | Primary |
Addresses
Primary practice location
1000 S Columbia Rd
Grand Forks, ND 58201-4032
Mailing address
1000 S Columbia Rd
Grand Forks, ND 58201-4032
Phone (701) 780-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55730 | Medicaid | ND |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1142 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinic Pharmacy Inc | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Devils Lake, ND
- NPI 1184718876
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435795200000",
"number": "1346545092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 S COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014032",
"telephone_number": "701-780-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582014032",
"telephone_number": "701-780-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "BROOKE",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-11",
"last_updated": "2015-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ND",
"license": "1142",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55730",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.