Active NPI
Evana Ruth Sandusky, CCC-SLP
- Speech-Language Pathologist
- McLeansboro, IL
National Provider Identifier
1689737801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.008291
- Practice address
- 9689 County Road 975 N
MC Leansboro, IL 62859-2089 - Phone
- (618) 967-2113
- Fax
- (618) 643-3916
- NPI assigned
- Dec 18, 2006
- Last updated
- May 24, 2016
- 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 | 146.008291 | IL | Primary |
Addresses
Primary practice location
9689 County Road 975 N
MC Leansboro, IL 62859-2089
Mailing address
9689 County Road 975 N
MC Leansboro, IL 62859-2089
Phone (618) 967-2113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03332004 | Other | IL | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 146.008291 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1689737801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9689 COUNTY ROAD 975 N",
"city": "MC LEANSBORO",
"state": "IL",
"postal_code": "628592089",
"telephone_number": "618-967-2113",
"fax_number": "618-643-3916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9689 COUNTY ROAD 975 N",
"city": "MC LEANSBORO",
"state": "IL",
"postal_code": "628592089",
"telephone_number": "618-967-2113",
"fax_number": "618-643-3916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDUSKY",
"first_name": "EVANA",
"middle_name": "RUTH",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.008291",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "03332004",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in McLeansboro, IL
- Mildred Louise Pate, DT
- Petersen Health Operations, LLC (McLeansboro Rehabilitation & Health Care Center)
- Jared Pryer, LPC
- Rci WRS Inc
- Robert Brad Ringhofer, M.D.
- Kathryn J Seely, PT
- Silver Foxes Senior Living & Rehabilitation LLC (Silver Foxes Senior Living & Rehabilitation)
- Spencer Family Eye Care, LLC
- Jennifer Lynn Steele, P.T.A.
- TDL Group, Inc. (Viewfinder)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.