Jacquelyn Marie Fortner, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

016472 Issued in OR

Practice address

3265 Biddle Rd
Medford, OR 97504-4122

Phone

(541) 816-4747

NPI assigned

Mar 26, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Rogue Pediatric Therapies, LLC

  • Speech-Language Pathologist
  • Medford, OR
  • NPI 1811388119
  NPD (past)

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1104387703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 LARKFIELD MAPLES CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031486",
            "telephone_number": "530-859-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 BIDDLE RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044122",
            "telephone_number": "541-816-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTNER",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-26",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "27301",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "016472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lee Forshaw, DMD
• Elena Tovkan Forster, PA
• John L Forsyth, MD
• Christine Seidl Forsythe, BS
• Dustin Garrett Fortado, CRM
• Melissa Ann Fossum, PHARM D
• Anessa Eve Foster
• Christopher Eugene Foster, PT
• Sharon Foster
• William Austin Foster, MD

• All providers in Medford, OR
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; 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.