Active NPI
Kelley Marie Edelbrock, M.A. CCC-SLP
- Speech-Language Pathologist
- Granger, IN
National Provider Identifier
1801005830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22001967A
- Practice address
- 14700 Horseshoe Bend CT
Granger, IN 46530-8269 - Phone
- (574) 271-9079
- NPI assigned
- May 22, 2007
- 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 | 22001967A | IN | Primary |
Addresses
Primary practice location
14700 Horseshoe Bend CT
Granger, IN 46530-8269
Mailing address
14700 Horseshoe Bend CT
Granger, IN 46530-8269
Phone (574) 271-9079
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200655050 | Other | IN | FIRST STEPS- |
| 200718460 | Other | IN | FIRST STEPS PROVIDOR # |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22001967A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801005830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14700 HORSESHOE BEND CT",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308269",
"telephone_number": "574-271-9079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14700 HORSESHOE BEND CT",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308269",
"telephone_number": "574-271-9079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELBROCK",
"first_name": "KELLEY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22001967A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST STEPS-",
"identifier": "200655050",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST STEPS PROVIDOR #",
"identifier": "200718460",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granger, IN
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.