NPIMap

Organization Active NPI

Pediatric Feeding Therapy, S.C.

  • Speech-Language Pathologist
  • Mount Horeb, WI
National Provider Identifier
1649844556
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
PEDIATRIC FEEDING THERAPY, S.C.
Practice address
200 W Main St Ste 102
Mount Horeb, WI 53572-1962
Phone
(651) 485-1376
NPI assigned
May 14, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Kelly Lonergan, MS, CCC-SLPNPI 1558535583
Title
Speech-Language Pathologist
Phone
(651) 485-1376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

200 W Main St Ste 102
Mount Horeb, WI 53572-1962

Mailing address

410 Park View Dr
Mount Horeb, WI 53572-1635

National Provider Directory

National Provider Directory

Locations

200 W Main St
Ste 102
Mount Horeb, WI 53572
Phone (608) 218-5631

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1649844556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 PARK VIEW DR",
            "city": "MOUNT HOREB",
            "state": "WI",
            "postal_code": "535721635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W MAIN ST STE 102",
            "city": "MOUNT HOREB",
            "state": "WI",
            "postal_code": "535721962",
            "telephone_number": "651-485-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC FEEDING THERAPY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "LONERGAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "651-485-1376",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Horeb, WI

Sources for this page

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

Verify at the official NPI Registry.