Active NPI
Kaide Jackstadt
- Speech-Language Pathologist
- Glen Carbon, IL
National Provider Identifier
1942743703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.003619
- Practice address
- 93 S Main St
Glen Carbon, IL 62034-1413 - Phone
- (618) 420-3999
- NPI assigned
- Nov 28, 2016
- 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 | 242.003619 | IL | Primary |
Addresses
Primary practice location
93 S Main St
Glen Carbon, IL 62034-1413
Mailing address
93 S Main St
Glen Carbon, IL 62034-1413
Phone (618) 420-3999
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 |
|---|---|---|---|
| 242.003619 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480291200000",
"number": "1942743703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "93 S MAIN ST",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620341413",
"telephone_number": "618-420-3999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "93 S MAIN ST",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620341413",
"telephone_number": "618-420-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSTADT",
"first_name": "KAIDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-28",
"last_updated": "2016-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.003619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.