NPIMap

Andrea M Kellerman

Individual provider Active NPI Speech-Language Pathologist · Bismarck, MO

NPI 1598020133 · NPPES record last updated Jul 10, 2012

Key facts

NPI
1598020133
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
2012020964 (MO)
Practice address
101 Dennis Dr
Special Services -- Claim Care
Bismarck, MO 63624-9075
Phone
(573) 734-6111
Fax
(573) 734-2957
NPI assigned
Jul 10, 2012
Sex
Female
Sole proprietor
Yes

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2012020964MOMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bismarck R-V School District Speech-Language Pathologist Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2012020964 MO Yes

Addresses

Primary practice location

101 Dennis Dr
Special Services -- Claim Care
Bismarck, MO 63624-9075

Mailing address

101 Dennis Dr
Special Services -- Claim Care
Bismarck, MO 63624-9075
Phone (573) 734-6111

Other providers in Bismarck, MO

All providers in Bismarck, MO · Speech-Language Pathologist in Missouri

Sources for this page

Verify at the official NPI Registry.