Active NPI
Kelli Nicole Humbert
- Speech-Language Pathologist
- Portage, WI
National Provider Identifier
1821405697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4603-154
- Practice address
- 626 E Slifer St
Cesa 5
Portage, WI 53901-1224 - Phone
- (608) 745-5400
- NPI assigned
- Jul 14, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 4603-154 | WI | Primary |
Addresses
Primary practice location
626 E Slifer St
Cesa 5
Portage, WI 53901-1224
Mailing address
306 Lilac LN
Holmen, WI 54636-7315
Phone (815) 326-1539
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 |
|---|---|---|---|
| 4603-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419292800000",
"number": "1821405697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 LILAC LN",
"city": "HOLMEN",
"state": "WI",
"postal_code": "546367315",
"telephone_number": "815-326-1539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 E SLIFER ST",
"address_2": "CESA 5",
"city": "PORTAGE",
"state": "WI",
"postal_code": "539011224",
"telephone_number": "608-745-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMBERT",
"first_name": "KELLI",
"middle_name": "NICOLE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-14",
"last_updated": "2014-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "4603-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.