Active NPI
Amanda Rideout
- Speech-Language Pathologist
- House Springs, MO
National Provider Identifier
1477014777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2018017689
- Practice address
- 4290 Gravois Rd
House Springs, MO 63051-2301 - Phone
- (636) 677-3473
- NPI assigned
- Mar 28, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2018017689 | MO | Primary |
Addresses
Primary practice location
4290 Gravois Rd
House Springs, MO 63051-2301
Mailing address
4290 Gravois Rd
House Springs, MO 63051-2301
Phone (636) 677-3473
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 |
|---|---|---|---|
| 2018017689 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553731200000",
"number": "1477014777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4290 GRAVOIS RD",
"city": "HOUSE SPRINGS",
"state": "MO",
"postal_code": "630512301",
"telephone_number": "636-677-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4290 GRAVOIS RD",
"city": "HOUSE SPRINGS",
"state": "MO",
"postal_code": "630512301",
"telephone_number": "636-677-3473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDEOUT",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-28",
"last_updated": "2019-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2018017689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in House Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.