Individual provider Active NPI

Jessica Susan Miner, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Flower Mound, TX
National Provider Identifier
1023658309
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
115880 Issued in TX
Practice address
1001 Cross Timbers Rd Ste 1240
Flower Mound, TX 75028-8866
Phone
(972) 966-1079
NPI assigned
Jan 14, 2020
Last updated
Jan 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

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 115880 TX Primary

Addresses

Primary practice location

1001 Cross Timbers Rd Ste 1240
Flower Mound, TX 75028-8866

Mailing address

2601 Lakeside Pkwy Apt 311
Flower Mound, TX 75022-4298
Phone (801) 722-9803

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
115880TXMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Christina Dellanebbia PHD Inc CurrentSince Jan 19, 2020 Accepting new patients

Locations

1001 Cross Timbers Rd
Ste 1240
Flower Mound, TX 75028
Phone (972) 539-8111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1023658309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 LAKESIDE PKWY APT 311",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750224298",
            "telephone_number": "801-722-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CROSS TIMBERS RD STE 1240",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750288866",
            "telephone_number": "972-966-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINER",
        "first_name": "JESSICA",
        "middle_name": "SUSAN",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "115880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; 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.