Individual provider Active NPI

Jessica Fetky, M.S., CCC-SLP

  • Speech-Language Pathologist
  • White Plains, NY
National Provider Identifier
1184903288
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
020920-1 Issued in NY
Practice address
333 Westchester Ave
Suite 202
White Plains, NY 10604-2910
Phone
(914) 328-2868
Fax
(914) 328-2973
NPI assigned
Aug 8, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 020920-1 NY Primary

Addresses

Primary practice location

333 Westchester Ave
Suite 202
White Plains, NY 10604-2910

Mailing address

12 Laurel St
Apt C5
Rye, NY 10580-8801
Phone (646) 320-0491

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
020920-1NYMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1312761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1184903288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 LAUREL ST",
            "address_2": "APT C5",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105808801",
            "telephone_number": "646-320-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WESTCHESTER AVE",
            "address_2": "SUITE 202",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106042910",
            "telephone_number": "914-328-2868",
            "fax_number": "914-328-2973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETKY",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-08",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "020920-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Plains, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.