Active NPI
Page Ellen Mayberry, MS, CCC-SLP
- Speech-Language Pathologist
- Monticello, IN
National Provider Identifier
1417419847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22007142A
- Practice address
- 1120 N Main St
Monticello, IN 47960-1500 - Phone
- (574) 583-7073
- NPI assigned
- Apr 4, 2019
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 28687 | CA | |
| Speech-Language Pathologist | 235Z00000X | SLP.0003603 | CO | |
| Speech-Language Pathologist | 235Z00000X | SP.13902 | OH | |
| Speech-Language Pathologist | 235Z00000X | SLP12090 | AZ | |
| Speech-Language Pathologist | 235Z00000X | 22007142A | IN | Primary |
Addresses
Primary practice location
1120 N Main St
Monticello, IN 47960-1500
Mailing address
8734 Bluebird Dr
West Chester, OH 45069-3458
Phone (513) 504-7650
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28687 | CA | MD | Clinical Social Worker |
| SLP12090 | AZ | MD | Speech-Language Pathologist |
| SLP.0003603 | CO | MD | Speech-Language Pathologist |
| 22007142A | IN | MD | Speech-Language Pathologist |
| SP.13902 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597017600000",
"number": "1417419847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8734 BLUEBIRD DR",
"city": "WEST CHESTER",
"state": "OH",
"postal_code": "450693458",
"telephone_number": "513-504-7650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 N MAIN ST",
"city": "MONTICELLO",
"state": "IN",
"postal_code": "479601500",
"telephone_number": "574-583-7073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBERRY",
"first_name": "PAGE",
"middle_name": "ELLEN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-04",
"last_updated": "2020-08-10",
"certification_date": "2020-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "28687",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CO",
"license": "SLP.0003603",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP.13902",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP12090",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22007142A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.