Kelli Murdock Eickelberg, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

10960 Issued in OR

Practice address

7701 SW Cirrus Drive, Suite 32-D
Beaverton, OR 97008-5966

Phone

(503) 520-5030

Fax

(503) 520-5090

NPI assigned

Apr 2, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1598886111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7701 SW CIRRUS DRIVE, SUITE 32-D",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970085966",
            "telephone_number": "503-520-5030",
            "fax_number": "503-520-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 SW CIRRUS DRIVE, SUITE 32-D",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970085966",
            "telephone_number": "503-520-5030",
            "fax_number": "503-520-5090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12220 SW 1st St",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970052848",
            "country_code": "US",
            "telephone_number": "503-520-5030",
            "fax_number": "503-520-5090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EICKELBERG",
        "first_name": "KELLI",
        "middle_name": "MURDOCK",
        "name_prefix": "Ms.",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "10960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGAON STATE LICENSE",
            "identifier": "10960",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE LICENSE",
            "identifier": "LL60802215",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Beaverton",
            "affiliation": "N",
            "address_1": "7701 SW Cirrus Dr Ste 32-D",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970085966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.