Individual provider Active NPI

Amanda J Johnson, SPEECH THERAPIST

  • Speech-Language Pathologist
  • Peoria, IL
National Provider Identifier
1710011077
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
507 E Armstrong Ave
Peoria, IL 61603-3201
Phone
(309) 686-1177
Fax
(309) 687-2035
NPI assigned
Mar 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X IL Primary

Addresses

Primary practice location

507 E Armstrong Ave
Peoria, IL 61603-3201

Mailing address

8 Rosewood CT
Bloomington, IL 61704-4834
Phone (309) 738-4906

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
146-008776ILMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710011077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 ROSEWOOD CT",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044834",
            "telephone_number": "309-738-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-686-1177",
            "fax_number": "309-687-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "SPEECH THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.