Active NPI
Grace Nichole Nicata Portentoso
- Speech-Language Pathologist
- Toledo, OH
National Provider Identifier
1104549831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- COND.20222021-SP
- Practice address
- 1205 King Rd
Toledo, OH 43617-2013 - Phone
- (419) 867-5666
- NPI assigned
- Sep 19, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | COND.20222021-SP | OH | Primary |
Addresses
Primary practice location
1205 King Rd
Toledo, OH 43617-2013
Mailing address
1205 King Rd
Toledo, OH 43617-2013
Phone (419) 867-5666
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | graceportentoso@springfield-schools.org |
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 |
|---|---|---|---|
| COND.20222021-SP | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1104549831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 KING RD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436172013",
"telephone_number": "419-867-5666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1205 KING RD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436172013",
"telephone_number": "419-867-5666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTENTOSO",
"first_name": "GRACE",
"middle_name": "NICHOLE NICATA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "COND.20222021-SP",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "graceportentoso@springfield-schools.org",
"affiliation": "N",
"address_1": "1205 King Rd",
"city": "Toledo",
"state": "OH",
"country_code": "US",
"postal_code": "436172013",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.