Active NPI
Jerilyn Ingram, MED CCC-SLP
- Speech-Language Pathologist
- Whitsett, NC
National Provider Identifier
1114211869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8402
- Practice address
- 6612 Jockey Club Drive
Whitsett, NC 27377 - Phone
- (336) 230-5213
- NPI assigned
- May 29, 2011
- 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 | 8402 | NC | Primary |
Addresses
Primary practice location
6612 Jockey Club Drive
Whitsett, NC 27377
Mailing address
952 Golf House Rd W., Ste I PMB 102
Whitsett, NC 27377
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)
- Enrolled
- Credentials
- Master of Education
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Health and Rehab | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Winston Salem, NC
- NPI 1134412273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615248000000",
"number": "1114211869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "952 GOLF HOUSE RD W., STE I PMB 102",
"city": "WHITSETT",
"state": "NC",
"postal_code": "27377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6612 JOCKEY CLUB DRIVE",
"city": "WHITSETT",
"state": "NC",
"postal_code": "27377",
"telephone_number": "336-230-5213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "JERILYN",
"credential": "MED CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-29",
"last_updated": "2021-03-09",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "8402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whitsett, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.