Active NPI
Mattison Idell Anderson
- Speech-Language Pathologist
- Callaway, NE
National Provider Identifier
1376154252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 772
- Practice address
- 101 N, S Needham Ave
Callaway, NE 68825 - Phone
- (308) 836-2272
- NPI assigned
- Aug 13, 2020
- 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 | 772 | NE | Primary |
Addresses
Primary practice location
101 N, S Needham Ave
Callaway, NE 68825
Mailing address
44120 Road 756
Lexington, NE 68850-3754
Phone (308) 746-1823
Other practice location 1
76 Plaza Blvd
Kearney, NE 68845-4841
Phone (308) 237-5927
Other practice location 2
405 N Haskell St
Arnold, NE 69120-6828
Phone (308) 848-2226
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 |
|---|---|---|---|
| 772 | NE | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Educational Service Unit 10 | Past | Accepting new patients | |
| County of Custer School District 89 | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Local Education Agency (LEA)
- Arnold, NE
- NPI 1881314110
-
- Local Education Agency (LEA)
- Kearney, NE
- NPI 1386386738
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1376154252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44120 ROAD 756",
"city": "LEXINGTON",
"state": "NE",
"postal_code": "688503754",
"telephone_number": "308-746-1823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 N, S NEEDHAM AVE",
"city": "CALLAWAY",
"state": "NE",
"postal_code": "68825",
"telephone_number": "308-836-2272"
}
],
"practiceLocations": [
{
"address_1": "76 Plaza Blvd",
"address_purpose": "LOCATION",
"city": "Kearney",
"state": "NE",
"postal_code": "688454841",
"country_code": "US",
"telephone_number": "308-237-5927",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "405 N Haskell St",
"address_purpose": "LOCATION",
"city": "Arnold",
"state": "NE",
"postal_code": "691206828",
"country_code": "US",
"telephone_number": "308-848-2226",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "MATTISON",
"middle_name": "IDELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-13",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NE",
"license": "772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Callaway, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.