Alexis J Dettmer

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.011647 Issued in IL

Practice address

240 Hawthorne Blvd
Glen Ellyn, IL 60137-4038

Phone

(163) 053-4742

NPI assigned

Apr 24, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1699462168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5716 LEE AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605161143",
            "telephone_number": "630-534-7428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 HAWTHORNE BLVD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374038",
            "telephone_number": "163-053-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMER",
        "first_name": "ALEXIS",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.011647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.