Kelly Mikoda, M. A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146007648 Issued in IL

Practice address

1260 Averill Dr
Batavia, IL 60510-3596

Phone

(630) 673-0221

NPI assigned

Apr 27, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Qualified Speech Language Pathologist

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1962857946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 AVERILL DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605103596",
            "telephone_number": "630-673-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 AVERILL DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605103596",
            "telephone_number": "630-673-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKODA",
        "first_name": "KELLY",
        "credential": "M. A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146007648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Batavia, IL
• Providers in Batavia, 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 Apr 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.