NPIMap

Organization Active NPI

Poplar Bluff School District

  • Speech-Language Pathologist
  • Poplar Bluff, MO
National Provider Identifier
1689807588
Registry record updated Aug 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2009013434 Issued in MO
Legal business name
POPLAR BLUFF SCHOOL DISTRICT
Practice address
1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336
Phone
(573) 785-6707
NPI assigned
Aug 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2009

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

Authorized official

Name
Dawn Hicks
Title
Medicaid Secretary
Phone
(573) 785-6707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 2009013434 MO Primary

Addresses

Primary practice location

1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336

Mailing address

1110 N Westwood Blvd
Poplar Bluff, MO 63901-3336

Other identifiers 2

IdentifierTypeStateIssuer
MO29-64MedicaidMO
2009013434OtherMOSPEECH AND LANGAUGE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1251244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251244800000",
    "number": "1689807588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013336",
            "telephone_number": "573-785-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF SCHOOL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-26",
        "last_updated": "2009-08-26",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "MEDICAID SECRETARY",
        "authorized_official_telephone_number": "573-785-6707"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2009013434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MO29-64",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH AND LANGAUGE",
            "identifier": "2009013434",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; 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.