Charnelle Nicole Brinker
Individual provider Active NPI Speech-Language Pathologist · Macomb, IL
NPI 1497212864 · NPPES record last updated Feb 21, 2019
Key facts
- NPI
- 1497212864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 242005199 (IL)
- Practice address
- 1 University Cir
Macomb, IL 61455-1367 - Phone
- (575) 799-8657
- NPI assigned
- Feb 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242005199 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 242005199 | IL | Yes |
Addresses
Primary practice location
1 University Cir
Macomb, IL 61455-1367
Mailing address
2219 Joyce LN
Springfield, IL 62703-3322
Phone (217) 416-0334
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All providers in Macomb, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.