Individual provider Active NPI

Jacqueline Stennis, SPEECH PATHOLOGIST

  • Speech-Language Pathologist
  • Saint Louis, MO
National Provider Identifier
1013385269
Registry record updated Sep 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
11960 Westline Industrial Dr Ste 201
Saint Louis, MO 63146-3209
Phone
(314) 819-0480
Fax
(314) 275-7444
NPI assigned
Sep 4, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2015

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 MO Primary

Addresses

Primary practice location

11960 Westline Industrial Dr Ste 201
Saint Louis, MO 63146-3209

Mailing address

11960 Westline Industrial Dr Ste 201
Saint Louis, MO 63146-3209
Phone (314) 819-0480

Other names 1

  • Miss Jacqueline Sue Barham Former name

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Supplemental Health Care Past Accepting new patients
Supplemental Health Care Past Accepting new patients

Organizations & group practices 2

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": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441324800000",
    "number": "1013385269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR STE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480",
            "fax_number": "314-275-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR STE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "314-819-0480",
            "fax_number": "314-275-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STENNIS",
        "first_name": "JACQUELINE",
        "name_prefix": "Mrs.",
        "credential": "SPEECH PATHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-04",
        "last_updated": "2015-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "BARHAM",
            "middle_name": "SUE",
            "prefix": "MISS",
            "credential": "SPEECH PATHOLOGIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.