Active NPI
Madelaine Fencl
- Speech-Language Pathologist
- O Fallon, MO
National Provider Identifier
1922653211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2019021483
- Practice address
- 610 Prince Ruppert Dr
O Fallon, MO 63366-1802 - Phone
- (636) 272-2709
- NPI assigned
- Aug 5, 2019
- 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 | 2019021483 | MO | Primary |
Addresses
Primary practice location
610 Prince Ruppert Dr
O Fallon, MO 63366-1802
Mailing address
12709 Parkway Estates Dr
Saint Louis, MO 63146-3710
Phone (314) 691-9997
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 |
|---|---|---|---|
| 2019021483 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639008000000",
"number": "1922653211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12709 PARKWAY ESTATES DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463710",
"telephone_number": "314-691-9997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 PRINCE RUPPERT DR",
"city": "O FALLON",
"state": "MO",
"postal_code": "633661802",
"telephone_number": "636-272-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENCL",
"first_name": "MADELAINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-05",
"last_updated": "2021-12-09",
"certification_date": "2021-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "2019021483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.