Missouri Speech Therapy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

106670 Issued in MO

Legal business name

MISSOURI SPEECH THERAPY

Practice address

1009 Hwy B
Bolivar, MO 65613-8252

Phone

(417) 326-6754

NPI assigned

May 29, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Mary R Ethridge, M.S., CCC-SLP

Title

Speech/Language Pathologist

Phone

(417) 326-9464

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1821400474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 101ST RD",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138608",
            "telephone_number": "417-326-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 HWY B",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138252",
            "telephone_number": "417-326-6754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "ETHRIDGE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SPEECH/LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "417-326-9464",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "106670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER",
            "identifier": "1134399710",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Menm, LLC (Miracle-Ear)
• Emiliy Mesecher, PT, DPT
• Michele Vinson Investments LLC Dba Bolivar Manor House
• Jessica Lynn Miller, RD/LD
• Tommie L Miller, LCSW
• Cynthia Diane Mitchell, RN, BSN
• Coral Molina, DO
• Laura Beth Montgomery, O.D.
• Sara Montgomery, SLP
• Joseph Andrew Moore, MD

• Speech-Language Pathologist in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; 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.