Kelly Ann Buckles, MS, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3720 Issued in WI

Practice address

742 Sterbenz Dr
Hudson, WI 54016-8327

Phone

(715) 386-2128

Fax

(715) 386-6119

NPI assigned

Sep 7, 2012

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Croix Therapy Inc

  • Physical Therapist
  • Hudson, WI
  • NPI 1669672911
  Medicare reassignment NPD

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355788800000",
    "number": "1487903126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 STERBENZ DR",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168327",
            "telephone_number": "715-386-2128",
            "fax_number": "715-386-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 STERBENZ DR",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168327",
            "telephone_number": "715-386-2128",
            "fax_number": "715-386-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLES",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "MS, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2012-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "3720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3720",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Harold Broecker, MS, LMFT
• Michael Bruinooge, D.D.S.
• Jinger K Brulz, MSE CFY-SLP
• Laura Bryngelson
• Jenna Marie Buchanan
• Christopher Buege
• Anthony Buerger, PHARM.D.
• Building Blocks Therapy Nook LLC
• Kristina Burk, ATC
• Sarah Burke, M.D.

• Speech-Language Pathologist in Hudson, WI
• Providers in Hudson, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.