Active NPI
Diane Gardner
- Speech-Language Pathologist
- Liberty, MO
National Provider Identifier
1699895219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 01461
- Practice address
- 398 Blue Jay Dr
Liberty, MO 64068-1977 - Phone
- (816) 407-2315
- Fax
- (816) 407-1555
- NPI assigned
- Mar 29, 2007
- 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 | 01461 | MO | Primary |
Addresses
Primary practice location
398 Blue Jay Dr
Liberty, MO 64068-1977
Mailing address
2609 Glenn Hendren Dr
Liberty, MO 64068-1738
Phone (816) 407-4555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466887825 | Medicaid | MO |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01461 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519689600000",
"number": "1699895219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2609 GLENN HENDREN DR",
"city": "LIBERTY",
"state": "MO",
"postal_code": "640681738",
"telephone_number": "816-407-4555",
"fax_number": "816-781-6973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "398 BLUE JAY DR",
"city": "LIBERTY",
"state": "MO",
"postal_code": "640681977",
"telephone_number": "816-407-2315",
"fax_number": "816-407-1555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "DIANE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2018-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "01461",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "466887825",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Liberty, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.