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Kenyetta Booker

Speech-Language Pathologist β€’ Rogers, MN

Active NPI 1558107714 Individual Practitioner Female Practitioner Accepts Medicare assignment
Practice location in NPPES

13650 Marsh View Blvd Apt 102
Rogers, MN 553746034

Call 3183029192 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

13650 Marsh View Blvd Apt 102

Rogers, MN 553746034

Telephone 3183029192
Other Listings in Public Data

CMS Doctors and Clinicians lists 1 group name: Aegis Group Practice Llc. See the list

Source: CMS Doctors and Clinicians National Downloadable File, release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2014

Years since graduation

12 years (graduated 2014)

CMS Doctors and Clinicians data list 2014 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2024

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Kenyetta Booker has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Compared with the same specialty in Rogers and Minnesota

5 active clinicians are listed under Speech-Language Pathologist with a practice address in Rogers, MN (3,083 in Minnesota).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2026-01-19
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

License # reported to NPPES MN 529084

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Minnesota Board of Medical Practice.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - QUALIFIED SPEECH LANGUAGE PATHOLOGIST

Medicare Enrollment ID

I20250626001415

Enrollment State Jurisdiction

MN

PECOS Control ID

2860931078

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File

Aegis Group Practice Llc

16500 92nd Ave N, Maple Grove, MN 553115444

Phone: 7632480785

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

15 Historical Events
πŸ“
Updated Practice Location January 19, 2026

Registered at 13650 MARSH VIEW BLVD APT 102, ROGERS, MN 553746034 (Tel: 3183029192)

πŸ“
Updated Business Mailing Address January 19, 2026

Registered at 13650 MARSH VIEW BLVD APT 102, ROGERS, MN 553746034

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) January 19, 2026

Speech-Language Pathologist (license number reported to NPPES: MN 529084)

πŸ”„
NPI Profile Reactivated May 29, 2025

Record officially reactivated for active practice on May 29, 2025

πŸ“
Updated Practice Location May 29, 2025

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070 (Tel: 3183029192)

πŸ“
Updated Business Mailing Address May 29, 2025

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070

πŸ‘€
Provider Name / Credentials Updated May 29, 2025

Recorded as KENYETTA BOOKER

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) May 29, 2025

Speech-Language Pathologist (license number reported to NPPES: LA 7127)

⚠️
NPI Profile Deactivated May 02, 2025

NPPES lists this NPI as deactivated as of May 02, 2025; the reason is not published.

βœ…
NPI Profile Active July 06, 2024

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) July 06, 2024

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070 (Tel: 3183029192)

πŸ“
Business Mailing Address (Initial Record) July 06, 2024

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070

πŸ‘€
Provider Name / Credentials (Initial Record) July 06, 2024

Recorded as KENYETTA BOOKER

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) July 06, 2024

Speech-Language Pathologist (license number reported to NPPES: LA 7127)

🟒
Initial NPI Registration & Enumeration July 06, 2024

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1558107714
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 06, 2024
Last Update: January 19, 2026
Sole Proprietor: Yes

Mailing Address

13650 Marsh View Blvd Apt 102

Rogers, MN 553746034

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.