Kelly L Engebo, M.A.,SLP,CCC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL00002782 Issued in WA

Practice address

106 E 15TH St
Vancouver, WA 98663-3401

Phone

(360) 750-5850

Fax

(360) 750-7244

NPI assigned

Dec 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Kelly L Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Early Choice Pediatric Therapy, PLLC

  • Developmental Disabilities Clinic/Center
  • Vancouver, WA
  • NPI 1114098274
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457411001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W 36TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986601936",
            "telephone_number": "360-750-5850",
            "fax_number": "360-750-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E 15TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633401",
            "telephone_number": "360-750-5850",
            "fax_number": "360-750-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGEBO",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "M.A.,SLP,CCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00002782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JACKSON",
            "middle_name": "L",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Susan Benson Emrick, LCSW
• Richard Allen Enders Jr., PAC
• Elizabeth Eneas
• Peter Way Eng, RPH
• Stephen Paul Engard, PA-C
• Jacqueline S. Engel, N.D., L.M.T.
• Joshua Engel
• Lori L Engel, RN
• Richard Engel Jr., RN
• Matthew Engelking, LMFT

• Speech-Language Pathologist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.