Individual provider Active NPI

Kimberly Erin Soderberg, CF-SLP

  • Speech-Language Pathologist
  • Aurora, IL
National Provider Identifier
1912523598
Registry record updated Jun 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
242.005893 Issued in IL
Practice address
452 N Eola Rd Ste a
Aurora, IL 60502-9110
Phone
(888) 308-3728
NPI assigned
Jun 19, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 242.005893 IL Primary

Addresses

Primary practice location

452 N Eola Rd Ste a
Aurora, IL 60502-9110

Mailing address

W144N9723 Elmwood Dr
Germantown, WI 53022-6609
Phone (262) 385-8074

Other practice location 1

29 Stonehill Rd Unit D
Oswego, IL 60543-9449
Phone (888) 308-3728

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

LicenseStateTypeSpecialty
242.005893ILMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1912523598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W144N9723 ELMWOOD DR",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226609",
            "telephone_number": "262-385-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 N EOLA RD STE A",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605029110",
            "telephone_number": "888-308-3728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29 Stonehill Rd Unit D",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "IL",
            "postal_code": "605439449",
            "country_code": "US",
            "telephone_number": "888-308-3728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SODERBERG",
        "first_name": "KIMBERLY",
        "middle_name": "ERIN",
        "credential": "CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.005893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.