Individual provider Active NPI

Jennifer M Stump, MED. CCC-SLP

  • Speech-Language Pathologist
  • Valdosta, GA
National Provider Identifier
1003050030
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP007035 Issued in GA
Practice address
2301 Bemiss Rd
Valdosta, GA 31602-1934
Phone
(229) 244-1667
Fax
(229) 244-8253
NPI assigned
Apr 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP007035 GA Primary

Addresses

Primary practice location

2301 Bemiss Rd
Valdosta, GA 31602-1934

Mailing address

2301 Bemiss Rd
Valdosta, GA 31602-1934
Phone (229) 244-1667

Other practice location 1

2704 N Oak St Bldg K
Valdosta, GA 31602-1769
Phone (229) 219-7993

Other identifiers 1

IdentifierTypeStateIssuer
291527995DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210629001542 GA Practitioner - Qualified Speech Language Pathologist 6608277538 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SLP007035GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Azalea Rehab Services, LLC Speech-Language Pathologist CurrentSince Jun 1, 2021 Accepting new patients
Therapyworks Pediatric Center LLC Speech-Language Pathologist Past Accepting new patients
Choice Family Medicine, PC PastSince Jun 27, 2021 Accepting new patients

Locations

2301 Bemiss Rd
Valdosta, GA 31602
Phone (229) 244-1667

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1003050030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 BEMISS RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021934",
            "telephone_number": "229-244-1667",
            "fax_number": "229-244-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 BEMISS RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021934",
            "telephone_number": "229-244-1667",
            "fax_number": "229-244-8253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2704 N Oak St Bldg K",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316021769",
            "country_code": "US",
            "telephone_number": "229-219-7993",
            "fax_number": "229-219-7914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STUMP",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MED. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-21",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP007035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291527995D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.