Jacklyn Nicole Buddenhagen, MA.,CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

029245 Issued in NY

Practice address

217 5TH Ave
Bay Shore, NY 11706-6402

Phone

(631) 968-1140

NPI assigned

Jan 30, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1174087456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 DEAN ST",
            "city": "NORTH BABYLON",
            "state": "NY",
            "postal_code": "117034104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 5TH AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117066402",
            "telephone_number": "631-968-1140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Craig B Gariepy Ave",
            "address_purpose": "LOCATION",
            "city": "Islip Terrace",
            "state": "NY",
            "postal_code": "117522820",
            "country_code": "US",
            "telephone_number": "631-650-6545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUDDENHAGEN",
        "first_name": "JACKLYN",
        "middle_name": "NICOLE",
        "credential": "MA.,CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-30",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "029245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teessense F Brown, LPN
• Jeanne Katelyn Bryan, PHARMD
• Tapan Buch
• Amanda Mariechen Buck, PA
• Allison Dee Buckman
• Megan Bulanowski, MD
• Barbara Bumstead, NP-C, MSCN
• Deshauna Bunbury
• Buonadonna Shoprite LLC
• Alexa A Buongiorno

• Speech-Language Pathologist in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.