Krystal Jaquish, M.A., SLP-CCC, TSLD
Individual provider Active NPI Speech-Language Pathologist · Lewis, NY
NPI 1124495627 · NPPES record last updated Dec 7, 2020
Key facts
- NPI
- 1124495627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 027551 (NY)
- Practice address
- 8566 U.S. Route 9
Lewis, NY 12950 - Phone
- (518) 565-7036
- NPI assigned
- Aug 31, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 968174151 | NY | MD | Specialist |
| 027551 | NY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 968174151 | NY | |
| Speech-Language Pathologist | 235Z00000X | 027551 | NY | Yes |
Addresses
Primary practice location
8566 U.S. Route 9
Lewis, NY 12950
Mailing address
28 Hilton Ter
Willsboro, NY 12996-4042
Other practice location 1
116 Alexandria Ave
Ticonderoga, NY 12883-1644
Phone (518) 565-7017
Other providers in Lewis, NY
All providers in Lewis, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.