Katherine Lee Ellersieck-Gebert, MS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Foley, MO
NPI 1689714982 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689714982
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2002006584 (MO)
- Practice address
- 303 O Shaw Dr
Foley, MO 63347-3235 - Phone
- (636) 566-6269
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002006584 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2002006584 | MO | Yes |
Addresses
Primary practice location
303 O Shaw Dr
Foley, MO 63347-3235
Mailing address
303 O Shaw Dr
Foley, MO 63347-3235
Phone (636) 566-6269
Other providers in Foley, MO
All providers in Foley, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.