NPIMap

Randy Chapman

Individual provider Active NPI Speech-Language Pathologist · Granite City, IL

NPI 1992221667 · NPPES record last updated Aug 16, 2017

Key facts

NPI
1992221667
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
1954539 (IL)
Practice address
3200 Maryville Rd
Granite City, IL 62040-5144
Phone
(618) 451-5826
NPI assigned
Aug 15, 2017
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1954539ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
County of Madison Granite City Com Unit SCH Dist 9 Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1954539 IL Yes

Addresses

Primary practice location

3200 Maryville Rd
Granite City, IL 62040-5144

Mailing address

3200 Maryville Rd
Granite City, IL 62040-5144

Other providers in Granite City, IL

All providers in Granite City, IL · Speech-Language Pathologist in Illinois

Sources for this page

Verify at the official NPI Registry.