Active NPI
Jacqueline Friduss
- Speech-Language Pathologist
- San Jose, CA
National Provider Identifier
1043845118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 28486
- Practice address
- 826 N Winchester Blvd
San Jose, CA 95128-1313 - Phone
- (408) 337-2727
- NPI assigned
- Mar 9, 2020
- Last updated
- Oct 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Speech-Language Pathologist | 235Z00000X | 28486 | CA | Primary |
Addresses
Primary practice location
826 N Winchester Blvd
San Jose, CA 95128-1313
Mailing address
826 N Winchester Blvd
San Jose, CA 95128-1313
Phone (408) 337-2727
Other practice location 1
826 N Winchester Blvd
San Jose, CA 95128-1313
Phone (408) 337-2727
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28486 | CA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joy and Laughter Therapy | Past | Accepting new patients | |
| Center for Speech, Language and Occupational Therapy a Prof Corp | Speech-Language Pathologist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Fremont, CA
- NPI 1629120068
-
- Developmentally Disabled Services Day Training Agency
- San Jose, CA
- NPI 1588035331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603584000000",
"number": "1043845118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "826 N WINCHESTER BLVD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281313",
"telephone_number": "408-337-2727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "826 N WINCHESTER BLVD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281313",
"telephone_number": "408-337-2727"
}
],
"practiceLocations": [
{
"address_1": "826 N Winchester Blvd",
"address_purpose": "LOCATION",
"city": "San Jose",
"state": "CA",
"postal_code": "951281313",
"country_code": "US",
"telephone_number": "408-337-2727",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FRIDUSS",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-09",
"last_updated": "2020-10-25",
"certification_date": "2020-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "28486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.