Active NPI
Shanna Boyer
- Speech-Language Pathologist
- Peoria, IL
National Provider Identifier
1407330947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.004121
- Practice address
- 1819 W Northmoor Rd
Peoria, IL 61614-3332 - Phone
- (309) 692-9481
- Fax
- (309) 692-9738
- NPI assigned
- Sep 20, 2018
- 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 | 146.004121 | IL | Primary |
Addresses
Primary practice location
1819 W Northmoor Rd
Peoria, IL 61614-3332
Mailing address
1819 W Northmoor Rd
Peoria, IL 61614-3332
Phone (309) 692-9481
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 |
|---|---|---|---|
| 146.004121 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1407330947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1819 W NORTHMOOR RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143332",
"telephone_number": "309-692-9481",
"fax_number": "309-692-9738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1819 W NORTHMOOR RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616143332",
"telephone_number": "309-692-9481",
"fax_number": "309-692-9738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYER",
"first_name": "SHANNA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-20",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.004121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.