Active NPI
Sandra Gail Cunningham
- Speech-Language Pathologist
- Poplar Bluff, MO
National Provider Identifier
1487322152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 112485
- Practice address
- 3100 Warrior LN
Poplar Bluff, MO 63901-8686 - Phone
- (573) 429-6173
- NPI assigned
- Aug 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 112485 | MO | Primary |
Addresses
Primary practice location
3100 Warrior LN
Poplar Bluff, MO 63901-8686
Mailing address
3100 Warrior LN
Poplar Bluff, MO 63901-8686
Phone (573) 429-6173
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 |
|---|---|---|---|
| 112485 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630281600000",
"number": "1487322152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 WARRIOR LN",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018686",
"telephone_number": "573-429-6173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 WARRIOR LN",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018686",
"telephone_number": "573-429-6173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "SANDRA",
"middle_name": "GAIL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-30",
"last_updated": "2021-08-30",
"certification_date": "2021-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "112485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.