Active NPI
Raynell Douglas
- Speech-Language Pathologist
- Indianapolis, IN
National Provider Identifier
1609992155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22004180A
- Practice address
- 4740 Kingsway Dr
Indianapolis, IN 46205-1521 - Phone
- (317) 466-1000
- Fax
- (317) 466-2000
- NPI assigned
- Mar 22, 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 | 22004180A | IN | Primary |
Addresses
Primary practice location
4740 Kingsway Dr
Indianapolis, IN 46205-1521
Mailing address
5537 Fjord Dr Apt D
Indianapolis, IN 46250-1100
Phone (317) 466-1000
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 |
|---|---|---|---|
| 22004180A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1609992155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5537 FJORD DR APT D",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462501100",
"telephone_number": "317-466-1000",
"fax_number": "317-466-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 KINGSWAY DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462051521",
"telephone_number": "317-466-1000",
"fax_number": "317-466-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "RAYNELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22004180A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.