Jackie Bungo, MA/CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP6345 Issued in OH

Practice address

3590 State Route 59
Ravenna, OH 44266-1380

Phone

(330) 297-6708

NPI assigned

Sep 8, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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.

• Ravenna City School District

  • Occupational Therapist
  • Ravenna, OH
  • NPI 1164633426

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1134520364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 STATE ROUTE 59",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442661380",
            "telephone_number": "330-297-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 STATE ROUTE 59",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442661380",
            "telephone_number": "330-297-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNGO",
        "first_name": "JACKIE",
        "credential": "MA/CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-08",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP6345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA",
            "identifier": "12033476",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY",
            "identifier": "SP6345",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theodore A Buccilli Jr., DPM
• Buckeye Residential Solutions LLC
• Sophia Marie Buckson-Murphy
• Andrea Buffington, PTA
• Amber Elise Bulcroft
• Amber Bunyan
• Megan Marie Burkett
• Karen Lea Burkey, AU.D.
• David U Burkholder, M.ED., PC
• Jacqueline Marie Burks

• Speech-Language Pathologist in Ravenna, OH
• Providers in Ravenna, OH by specialty
• Speech-Language Pathologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.