Active NPI
Kersten Ann Mitchell
- Speech-Language Pathologist
- Washington, MO
National Provider Identifier
1679174189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2020022534
- Practice address
- 2300 Southbend Dr
Washington, MO 63090-3719 - Phone
- (636) 231-2700
- Fax
- (636) 231-2750
- NPI assigned
- Nov 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 2020022534 | MO | Primary |
Addresses
Primary practice location
2300 Southbend Dr
Washington, MO 63090-3719
Mailing address
1561 Camp St
Washington, MO 63090-5016
Phone (636) 399-1147
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 |
|---|---|---|---|
| 2020022534 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1679174189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1561 CAMP ST",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630905016",
"telephone_number": "636-399-1147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 SOUTHBEND DR",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630903719",
"telephone_number": "636-231-2700",
"fax_number": "636-231-2750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "KERSTEN",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2020022534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.