Individual provider Active NPI

Jenna Lynn Steinruck, MS CCC-SLP

  • Speech-Language Pathologist
  • Bethlehem, PA
National Provider Identifier
1104177468
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SL011062 Issued in PA
Practice address
1715 4TH St
Bethlehem, PA 18020-6516
Phone
(610) 462-5946
NPI assigned
Sep 27, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2014

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 SL011062 PA Primary

Addresses

Primary practice location

1715 4TH St
Bethlehem, PA 18020-6516

Mailing address

1715 4TH St
Bethlehem, PA 18020-6516
Phone (610) 462-5946

Other identifiers 1

IdentifierTypeStateIssuer
1023096950001MedicaidPA

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
SL011062PAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401235200000",
    "number": "1104177468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 4TH ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180206516",
            "telephone_number": "610-462-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 4TH ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180206516",
            "telephone_number": "610-462-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEINRUCK",
        "first_name": "JENNA",
        "middle_name": "LYNN",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-27",
        "last_updated": "2014-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL011062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023096950001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethlehem, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; 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.