Active NPI
Carla Adderley
- Speech-Language Pathologist
- Saint Louis, MO
National Provider Identifier
1902196017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 114493
- Practice address
- 1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181 - Phone
- (314) 607-0165
- NPI assigned
- Apr 10, 2011
- 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 | 114493 | MO | Primary |
Addresses
Primary practice location
1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181
Mailing address
3710 Sunerest Dr
Saint Louis, MO 63125-4241
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 |
|---|---|---|---|
| 114493 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crystal Oaks Long Term Care | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Skilled Nursing Facility
- Festus, MO
- NPI 1467592618
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725408000000",
"number": "1902196017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 SUNEREST DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631254241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 JEFFERSON BARRACKS DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631254181",
"telephone_number": "314-607-0165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADDERLEY",
"first_name": "CARLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-10",
"last_updated": "2024-09-04",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "114493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.