Scarlet Jo Conley
Individual provider Active NPI Speech-Language Pathologist · Charleston, IL
NPI 1699414201 · NPPES record last updated Jun 1, 2022
Key facts
- NPI
- 1699414201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146.004868 (IL)
- Practice address
- 1924 Reynolds Dr
Charleston, IL 61920-3157 - Phone
- (217) 639-4000
- NPI assigned
- Jun 1, 2022
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.004868 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.004868 | IL | Yes |
Addresses
Primary practice location
1924 Reynolds Dr
Charleston, IL 61920-3157
Mailing address
5378 NCR 1450 E
Charleston, IL 61920
Phone (217) 549-3766
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609972165 | Medicaid | IL |
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All providers in Charleston, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2022. 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.