Jaesan PC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

JAESAN PC

Practice address

3116 Milton Rd Ste F
Charlotte, NC 28215-5079

Phone

(980) 237-6226

Fax

(980) 237-6288

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Kai Ane Jerrell, M.A., CCC-SLPNPI 1699073197

Title

Ceo/Owner

Phone

(980) 237-6226

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SpeechWorks Therapy Services Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kai Jerrell, M.A. CCC-SLP

  • Speech-Language Pathologist
  • Charlotte, NC
  • NPI 1699073197
  Medicare reassignment Authorized official
• Alexandra Golkin, M.S., CCC - SLP

  • Speech-Language Pathologist
  • Charlotte, NC
  • NPI 1669004784
  NPD
• Chiqueeta Martin

  • Speech-Language Pathologist
  • Charlotte, NC
  • NPI 1164169470
  NPD
• Cristy Abel, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Granite Falls, NC
  • NPI 1720585813
  NPD (past)
• Holly Jones, M.S.., CCC-SLP

  • Speech-Language Pathologist
  • Granite Falls, NC
  • NPI 1841797875
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635292800000",
    "number": "1003940933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 MILTON RD STE F",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155079",
            "telephone_number": "980-237-6226",
            "fax_number": "980-237-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 MILTON RD STE F",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155079",
            "telephone_number": "980-237-6226",
            "fax_number": "980-237-6288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Falls Ave Ste 9A",
            "address_purpose": "LOCATION",
            "city": "Granite Falls",
            "state": "NC",
            "postal_code": "286301545",
            "country_code": "US",
            "telephone_number": "980-237-6226",
            "fax_number": "980-237-6288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JAESAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "JERRELL",
        "authorized_official_first_name": "KAI",
        "authorized_official_middle_name": "ANE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "980-237-6226",
        "authorized_official_credential": "M.A., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "5842",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "6278",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7411868",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212056",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SpeechWorks Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SpeechWorks Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Speech-Language Pathologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.