Kellie O'Brien Ivie

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.016263 Issued in IL

Practice address

5601 Brookmere St
Edwards, IL 61528-9408

Phone

(309) 363-7594

Fax

(309) 966-3621

NPI assigned

Aug 31, 2020

Last updated

Feb 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Way to Grow Pediatric Therapy Inc

  • Speech-Language Pathologist
  • Edwards, IL
  • NPI 1295208379
  NPD (past)

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1942814769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 BROOKMERE ST",
            "city": "EDWARDS",
            "state": "IL",
            "postal_code": "615289408",
            "telephone_number": "309-363-7594",
            "fax_number": "309-966-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 BROOKMERE ST",
            "city": "EDWARDS",
            "state": "IL",
            "postal_code": "615289408",
            "telephone_number": "309-363-7594",
            "fax_number": "309-966-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVIE",
        "first_name": "KELLIE",
        "middle_name": "O'BRIEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.016263",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.005831",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Alvey
• Savannah Andrews
• Barnewolt & Barnewolt Chiropractic PC
• Joshua Adam Barnewolt, DC
• Katherine E Barnewolt
• Movement Specialists Physical Therapy, LLC
• Sarah Myers, SLP
• Elizabeth Ann Neumann
• Paricia Rosenbaum, PTA
• Alexandria S Schaub

• Speech-Language Pathologist in Edwards, IL
• Providers in Edwards, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.