Individual provider Active NPI

Kelsey Ann Staples

  • Speech-Language Pathologist
  • Portland, ME
National Provider Identifier
1700308723
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP2897 Issued in ME
Practice address
222 Auburn St Ste 1G
Portland, ME 04103-6001
Phone
(207) 797-8255
NPI assigned
Jul 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP2897 ME Primary
Speech-Language Pathologist 235Z00000X 4731 OK

Addresses

Primary practice location

222 Auburn St Ste 1G
Portland, ME 04103-6001

Mailing address

222 Auburn St Ste 1G
Portland, ME 04103-6012
Phone (207) 797-8255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190923002116 ME Practitioner - Qualified Speech Language Pathologist 5193055861 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4731OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hammond Associates Inc Speech-Language Pathologist CurrentSince Sep 5, 2019 Accepting new patients
Therapysource for Kids, Inc. Speech-Language Pathologist Past Accepting new patients

Locations

1250 Forest Ave
Ste 301
Portland, ME 04103
Phone (207) 797-5753

222 Auburn St
Ste 1G
Portland, ME 04103
Phone (207) 797-8255

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1700308723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 AUBURN ST STE 1G",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041036012",
            "telephone_number": "207-797-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 AUBURN ST STE 1G",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041036001",
            "telephone_number": "207-797-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAPLES",
        "first_name": "KELSEY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ME",
            "license": "SP2897",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "4731",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.