Active NPI
Kathleen Chodur
- Speech-Language Pathologist
- Melbourne, FL
National Provider Identifier
1396365342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA15437
- Practice address
- 8705 N Wickham Rd
Melbourne, FL 32940-5997 - Phone
- (321) 434-9122
- NPI assigned
- Apr 20, 2020
- Last updated
- Nov 18, 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 | SA15437 | FL | Primary |
Addresses
Primary practice location
8705 N Wickham Rd
Melbourne, FL 32940-5997
Mailing address
3730 Brentwood CT
Melbourne, FL 32935-4731
Other practice location 1
255 Borman Dr
Merritt Island, FL 32953-3486
Phone (321) 434-5820
Other practice location 2
220 S Courtenay Pkwy Ste B
Merritt Island, FL 32952-4893
Phone (321) 434-5820
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M9168 | Other | FL | MEDICARE HF |
| PENDING | Medicaid | FL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1396365342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3730 BRENTWOOD CT",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329354731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8705 N WICKHAM RD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329405997",
"telephone_number": "321-434-9122"
}
],
"practiceLocations": [
{
"address_1": "255 Borman Dr",
"address_purpose": "LOCATION",
"city": "Merritt Island",
"state": "FL",
"postal_code": "329533486",
"country_code": "US",
"telephone_number": "321-434-5820",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "220 S Courtenay Pkwy Ste B",
"address_purpose": "LOCATION",
"city": "Merritt Island",
"state": "FL",
"postal_code": "329524893",
"country_code": "US",
"telephone_number": "321-434-5820",
"fax_number": "321-434-5821",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHODUR",
"first_name": "KATHLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-20",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA15437",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE HF",
"identifier": "M9168",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
- Chiro Choice a Limited Liability Company
- Chiropractic Envy Health & Wellness
- Chiropractic Specialist of Brevard, Inc. (Suntree Chiropractic)
- Chiropractuc Envy Health & Wellness
- Charles H. Chodorow, D.O.
- Ivy Chong, PHD
- Sarah Choo-Yick, MD
- Rahul R Chopra, M.D.
- Elizabeth Wyman Chrencik, MS, RD, LD/N
- Milad Chrieki, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.