Active NPI
Bethany Marie Kisner-Crosby, MA-SLP-CCC-L
- Speech-Language Pathologist
- Dekalb, IL
National Provider Identifier
1518096833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146005808
- Practice address
- 247 Tilton Park Dr
Dekalb, IL 60115-1955 - Phone
- (815) 739-1452
- Fax
- (815) 756-5359
- NPI assigned
- Mar 4, 2007
- 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 | 146005808 | IL | Primary |
Addresses
Primary practice location
247 Tilton Park Dr
Dekalb, IL 60115-1955
Mailing address
247 Tilton Park Dr
Dekalb, IL 60115-1955
Phone (815) 739-1452
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01926198 | Other | IL | BCBS |
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 |
|---|---|---|---|
| 146005808 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C & C Foundations LTD | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Freeport, IL
- NPI 1235625328
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422403200000",
"number": "1518096833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "247 TILTON PARK DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151955",
"telephone_number": "815-739-1452",
"fax_number": "815-756-5359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "247 TILTON PARK DR",
"city": "DEKALB",
"state": "IL",
"postal_code": "601151955",
"telephone_number": "815-739-1452",
"fax_number": "815-756-5359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISNER-CROSBY",
"first_name": "BETHANY",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "MA-SLP-CCC-L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-04",
"last_updated": "2015-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146005808",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01926198",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.