Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1558107714 Deactivated / Inactive NPI Female Practitioner

Kenyetta Booker

Speech-Language Pathologist • Rogers, MN

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Kenyetta Booker has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 06, 2024
NPI Deactivation Date May 02, 2025
Total Practice Duration ~11 Years of Practice (2014 – 2025)

Professional Overview & Biography Verified Profile Summary

Kenyetta Booker was a registered Speech-Language Pathologist practicing in Rogers, MN. Throughout an active medical career spanning 11 years, Kenyetta Booker provided care at the practice location at 13650 MARSH VIEW BLVD APT 102 until profile deactivation on 2025-05-02.

Kenyetta Booker was affiliated with Aegis Group Practice Llc and accepted Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

13650 Marsh View Blvd Apt 102

Rogers, MN 553746034

Telephone 3183029192

Medicare Profile & Education

Medical School

Other

Graduation Year

2014

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Rogers, MN

Established Specialist (10-20 Yrs)
Practitioner Clinical Experience
12 Yrs Matches City Avg
City Avg: 12.0 Yrs
State Avg: 11.7 Yrs
Regional Practice Density
5 Specialists

Practicing in Rogers, MN (3097 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Booker (12 Years) 12 Yrs
Rogers Specialty Average (12.0 Years) 12.0 Yrs

Medical Specialties & State Licenses

CMS Verified: 2026-01-19
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License 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.

Hospital & Practice Group Affiliations

Aegis Group Practice Llc

16500 92nd Ave N, Maple Grove, MN 553115444

Phone: 7632480785

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events
📍
Updated Practice Location January 19, 2026

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

📍
Updated Business Mailing Address January 19, 2026

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

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

Speech-Language Pathologist (License #529084 in MN)

📍
Updated Practice Location May 29, 2025

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

📍
Updated Business Mailing Address May 29, 2025

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070

👤
Provider Name / Credentials Updated May 29, 2025

Recorded as KENYETTA BOOKER

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

Speech-Language Pathologist (License #7127 in LA)

⚠️
NPI Profile Deactivated May 02, 2025

Record deactivated on May 02, 2025

NPI Profile Active July 06, 2024

NPI status registered as active in NPPES database

📍
Updated Practice Location July 06, 2024

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

📍
Updated Business Mailing Address July 06, 2024

Registered at 1666 HIGHWAY 156, WINNFIELD, LA 714835070

👤
Provider Name / Credentials Updated July 06, 2024

Recorded as KENYETTA BOOKER

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

Speech-Language Pathologist (License #7127 in LA)

🟢
Initial NPI Registration & Enumeration July 06, 2024

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Kenyetta Booker. Be the first to share your experience!

Sign in to leave a review for Kenyetta Booker

Only verified registered users can submit ratings, post feedback, and upload facility photos.

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
Deactivation Date: May 02, 2025
Sole Proprietor: Yes

Mailing Address

13650 Marsh View Blvd Apt 102

Rogers, MN 553746034

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.