Active NPI
Linda D Bryan
- Speech-Language Pathologist
- Centralia, IL
National Provider Identifier
1982930079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.003289
- Practice address
- 400 N Pleasant Ave
Centralia, IL 62801-3056 - Phone
- (618) 436-8637
- Fax
- (618) 436-8087
- NPI assigned
- Oct 23, 2009
- 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 | 146.003289 | IL | Primary |
Addresses
Primary practice location
400 N Pleasant Ave
Centralia, IL 62801-3056
Mailing address
PO Box 503861
Saint Louis, MO 63150-0001
Phone (618) 436-8637
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 |
|---|---|---|---|
| 146.003289 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256256000000",
"number": "1982930079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 503861",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631500001",
"telephone_number": "618-436-8637",
"fax_number": "618-436-8087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N PLEASANT AVE",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "628013056",
"telephone_number": "618-436-8637",
"fax_number": "618-436-8087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "LINDA",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-23",
"last_updated": "2009-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.003289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.