Active NPI
Nicole Lynn Marty, M.S. SLP
- Speech-Language Pathologist
- Washburn, IL
National Provider Identifier
1902315567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146006221
- Practice address
- 508 E Walnut St
Washburn, IL 61570-7539 - Phone
- (309) 248-7221
- Fax
- (309) 248-7518
- NPI assigned
- Sep 27, 2017
- Last updated
- Sep 27, 2017
- 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 | 146006221 | IL | Primary |
Addresses
Primary practice location
508 E Walnut St
Washburn, IL 61570-7539
Mailing address
205 S Englewood Dr
Metamora, IL 61548-8781
Phone (309) 367-4901
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146006221 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lowpoint Washburn Cu Dist 21 | Past | Accepting new patients | |
| Woodford County Spec Ed Assoc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Local Education Agency (LEA)
- Washburn, IL
- NPI 1356543870
-
- Local Education Agency (LEA)
- Metamora, IL
- NPI 1558563015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506470400000",
"number": "1902315567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 S ENGLEWOOD DR",
"city": "METAMORA",
"state": "IL",
"postal_code": "615488781",
"telephone_number": "309-367-4901",
"fax_number": "309-367-4905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 E WALNUT ST",
"city": "WASHBURN",
"state": "IL",
"postal_code": "615707539",
"telephone_number": "309-248-7221",
"fax_number": "309-248-7518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTY",
"first_name": "NICOLE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "M.S. SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-27",
"last_updated": "2017-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146006221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washburn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.