Individual provider Active NPI

Stephen David Judson

  • Speech-Language Pathologist
  • Springfield, IL
National Provider Identifier
1548932155
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146009399 Issued in IL
Practice address
128 N Douglas Ave
Springfield, IL 62702-4814
Phone
(630) 200-3222
NPI assigned
Oct 1, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 146009399 IL Primary

Addresses

Primary practice location

128 N Douglas Ave
Springfield, IL 62702-4814

Mailing address

128 N Douglas Ave
Springfield, IL 62702-4814
Phone (630) 200-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211014002145 IL Practitioner - Qualified Speech Language Pathologist 1850799271 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Empowerme Wellness Kansas City, LLC Speech-Language Pathologist CurrentSince Sep 1, 2024 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Sep 1, 2024 Accepting new patients
Empowerme Wellness Kansas City, LLC CurrentSince Sep 1, 2024 Accepting new patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Sep 7, 2021 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Sep 1, 2024 Accepting new patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Sep 7, 2021 Accepting new patients

Locations

1021 W E St
Belleville, IL 62220
Phone (618) 233-2095

7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759

1015 Oconor Ave
La Salle, IL 61301
Phone (224) 616-5446

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1548932155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 N DOUGLAS AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024814",
            "telephone_number": "630-200-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N DOUGLAS AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024814",
            "telephone_number": "630-200-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDSON",
        "first_name": "STEPHEN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146009399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.