Active NPI
Alexandra Komar
- Speech-Language Pathologist
- St Charles, IL
National Provider Identifier
1609345420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.005190
- Practice address
- 525 Tyler Rd Ste Q1
St Charles, IL 60174-3360 - Phone
- (630) 444-0077
- NPI assigned
- Nov 21, 2018
- Last updated
- Jan 14, 2021
- 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 | 242.005190 | IL | Primary |
Addresses
Primary practice location
525 Tyler Rd Ste Q1
St Charles, IL 60174-3360
Mailing address
525 Tyler Rd Ste Q1
St Charles, IL 60174-3360
Phone (630) 444-0077
Other practice location 1
1095 Pingree Rd Ste 209
Crystal Lake, IL 60014-1727
Phone (847) 458-8890
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 |
|---|---|---|---|
| 242.005190 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1609345420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 TYLER RD STE Q1",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601743360",
"telephone_number": "630-444-0077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 TYLER RD STE Q1",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601743360",
"telephone_number": "630-444-0077"
}
],
"practiceLocations": [
{
"address_1": "1095 Pingree Rd Ste 209",
"address_purpose": "LOCATION",
"city": "Crystal Lake",
"state": "IL",
"postal_code": "600141727",
"country_code": "US",
"telephone_number": "847-458-8890",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOMAR",
"first_name": "ALEXANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-21",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.005190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.