Active NPI
Suzanne Kelley
- Speech-Language Pathologist
- Washington, IL
National Provider Identifier
1790203768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1460005433
- Practice address
- 1719 Kingsbury Rd
Washington, IL 61571-9278 - Phone
- (309) 264-3565
- NPI assigned
- Aug 30, 2017
- 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 | 1460005433 | IL | Primary |
Addresses
Primary practice location
1719 Kingsbury Rd
Washington, IL 61571-9278
Mailing address
1719 Kingsbury Rd
Washington, IL 61571-9278
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146005433 | Other | IL | IDFPR |
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 |
|---|---|---|---|
| 1460005433 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504051200000",
"number": "1790203768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1719 KINGSBURY RD",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1719 KINGSBURY RD",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719278",
"telephone_number": "309-264-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SUZANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-30",
"last_updated": "2017-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "1460005433",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDFPR",
"identifier": "146005433",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.