Active NPI
Kyle Jennings
- Speech-Language Pathologist
- Arcadia, CA
National Provider Identifier
1174242556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 17086
- Practice address
- 301 E Foothill Blvd Ste 100
Arcadia, CA 91006-2551 - Phone
- (833) 319-3969
- NPI assigned
- Aug 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 | 17086 | CA | Primary |
Addresses
Primary practice location
301 E Foothill Blvd Ste 100
Arcadia, CA 91006-2551
Mailing address
301 E Foothill Blvd Ste 100
Arcadia, CA 91006-2551
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 |
|---|---|---|---|
| 17086 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661472000000",
"number": "1174242556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E FOOTHILL BLVD STE 100",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910062551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E FOOTHILL BLVD STE 100",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910062551",
"telephone_number": "833-319-3969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "KYLE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-26",
"last_updated": "2022-08-26",
"certification_date": "2022-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "17086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcadia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.