Makenna Green, MA, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242.005419 Issued in IL

Practice address

4058 E Main St
St Charles, IL 60174-5202

Phone

(630) 793-4464

NPI assigned

Jul 9, 2019

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

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Illinois UniversityGroup PAC ID 2860440195, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Northern Illinois University

  • Radiation Oncology Clinic/Center
  • Batavia, IL
  • NPI 1144327487

  IL

  Medicare reassignment Care Compare group NPD
• Northern Illinois University

  • Sports Medicine (Family Medicine) Physician
  • Dekalb, IL
  • NPI 1700332392
  NPD (past)
• Sennogroup, SC

  • Physical Medicine & Rehabilitation Physician
  • Northbrook, IL
  • NPI 1346486735
  NPD (past)
• Powerback Rehabilitation LLC

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1790640761

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1467004697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 HAMILTON RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601758009",
            "telephone_number": "630-677-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4058 E MAIN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745202",
            "telephone_number": "630-793-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MAKENNA",
        "name_prefix": "Mrs.",
        "credential": "MA, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.005419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Grams, PT
• Gray DME Solutions LLC
• Chelsea A Graziano, M.S. CCC-SLP
• Greater Good Chiropractic Care, LLC
• Greater Valley Medicine
• Robert Gregory, DC
• Kerry Ann Gremo
• Theresa Grimaldo
• Marissa Nora Groom, MS
• Grosskopf Orthopedic SC

• All providers in St Charles, IL
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.