Active NPI
Jacob Tyler Mordhorst, CF-SLP
- Speech-Language Pathologist
- Omaha, NE
National Provider Identifier
1154802585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 665
- Practice address
- 3706 Maple St
Omaha, NE 68111-3195 - Phone
- (402) 658-1083
- NPI assigned
- Aug 23, 2018
- Last updated
- Aug 23, 2018
- Sex
- Male
- 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 | 665 | NE | Primary |
Addresses
Primary practice location
3706 Maple St
Omaha, NE 68111-3195
Mailing address
3706 Maple St
Omaha, NE 68111-3195
Phone (402) 658-1083
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 |
|---|---|---|---|
| 665 | NE | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534982400000",
"number": "1154802585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3706 MAPLE ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681113195",
"telephone_number": "402-658-1083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3706 MAPLE ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681113195",
"telephone_number": "402-658-1083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORDHORST",
"first_name": "JACOB",
"middle_name": "TYLER",
"credential": "CF-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-23",
"last_updated": "2018-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NE",
"license": "665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.