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
- Last updated
- Sep 4, 2024
- 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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.