Elizabeth Mackle, CCC-SLP-L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146000985 Issued in IL

Practice address

128 Washington SQ
Washington, IL 61571-2657

Phone

(800) 773-1682

NPI assigned

May 2, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Liz Ryan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Skill Sprout, LLC

  • Behavior Analyst
  • Washington, IL
  • NPI 1659600948
  NPD (past)

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1841558335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 NORMAN DR",
            "city": "GROVELAND",
            "state": "IL",
            "postal_code": "615359770",
            "telephone_number": "309-387-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 WASHINGTON SQ",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615712657",
            "telephone_number": "800-773-1682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKLE",
        "first_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP-L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146000985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LIZ",
            "last_name": "RYAN",
            "credential": "CCC-SLP-L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Speech-Language Pathologist in Washington, IL
• Providers in Washington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.