Midwest Dysphagia Diagnostics PC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2012041520 Issued in MO

Legal business name

MIDWEST DYSPHAGIA DIAGNOSTICS PC

Practice address

1375 SW 100TH Rd
Holden, MO 64040-8440

Phone

(816) 986-0361

Fax

(816) 817-0922

NPI assigned

Apr 11, 2016

Last updated

Sep 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ashley Beam, MSCCC-SLP

Title

Speech Pathologist

Phone

(816) 986-0361

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Veronica Immethun, MS, CCC-SLP

  • Speech-Language Pathologist
  • Holden, MO
  • NPI 1528769908
  NPD (past)

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1497119887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 SW 100TH RD",
            "city": "HOLDEN",
            "state": "MO",
            "postal_code": "640408440",
            "telephone_number": "816-986-0361",
            "fax_number": "816-817-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 SW 100TH RD",
            "city": "HOLDEN",
            "state": "MO",
            "postal_code": "640408440",
            "telephone_number": "816-986-0361",
            "fax_number": "816-817-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST DYSPHAGIA DIAGNOSTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "BEAM",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "SPEECH PATHOLOGIST",
        "authorized_official_telephone_number": "816-986-0361",
        "authorized_official_credential": "MSCCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2012041520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA6285",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "KA4003",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Nicole Hoover, LPN
• Teri N Hughes, PTA
• Veronica Immethun, MS, CCC-SLP
• Shelly Maddox
• Midwest Division-LSH.LLC (Holden Family Health Clinic)
• Brandon Michael Sullivan, PHARMD
• The Dyslexia Den
• Audra Deborah Tinnin, CNP
• Trevi Enterprises LLC
• Dana J Van Meter Patton, M.S. CCC-SLP/L

• Speech-Language Pathologist in Holden, MO
• Providers in Holden, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; 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.