Active NPI
Bailey Chaklos
- Speech-Language Pathologist
- Bridgeton, MO
National Provider Identifier
1720780588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2022031592
- Practice address
- 12380 De Paul Dr
Bridgeton, MO 63044-2511 - Phone
- (314) 447-9710
- NPI assigned
- Mar 17, 2023
- Sex
- Male
- 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 | 2022031592 | MO | Primary |
Addresses
Primary practice location
12380 De Paul Dr
Bridgeton, MO 63044-2511
Mailing address
1210 Oxford Hill CT Apt 6
Saint Louis, MO 63146-5718
Phone (618) 578-8619
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2022031592 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679011200000",
"number": "1720780588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 OXFORD HILL CT APT 6",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631465718",
"telephone_number": "618-578-8619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12380 DE PAUL DR",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442511",
"telephone_number": "314-447-9710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAKLOS",
"first_name": "BAILEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-17",
"last_updated": "2023-03-17",
"certification_date": "2023-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2022031592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.