Carly Marie Kupersmith
Individual provider Active NPI Speech-Language Pathologist · Geneseo, IL
NPI 1780163501 · NPPES record last updated Aug 13, 2018
Key facts
- NPI
- 1780163501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 415 N Russell Ave
Geneseo, IL 61254-2044 - Phone
- (309) 945-0625
- NPI assigned
- Aug 13, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
415 N Russell Ave
Geneseo, IL 61254-2044
Mailing address
310 20TH Ave W
Milan, IL 61264-3365
Phone (815) 990-6803
Other practice location 1
920 S Congress St
Geneseo, IL 61254-1808
Phone (309) 945-0475
Other providers in Geneseo, IL
- Johanna Hager LCPC
- John Leno, M.D. S.C.
- Michael Klein
- Sara Marie Kohrs
- Michael Wayne Kosman
- Even C Kvelland
- Jamie Eileen Lambin
- Kailey Nicole Limes
- Daniel R Lommell
- John Alan Loucks
All providers in Geneseo, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.