Individual provider Active NPI

Jordyn Sebastian, SLP

  • Speech-Language Pathologist
  • Livonia, MI
National Provider Identifier
1194367292
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7101008444 Issued in MI
Practice address
11878 Hubbard St Ste 100
Livonia, MI 48150-1733
Phone
(734) 953-1745
Fax
(734) 953-1743
NPI assigned
Oct 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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 7101008444 MI Primary

Addresses

Primary practice location

11878 Hubbard St Ste 100
Livonia, MI 48150-1733

Mailing address

4949 Coolidge Hwy
Royal Oak, MI 48073-1026
Phone (248) 655-5880

Other practice location 1

4949 Coolidge Hwy
Royal Oak, MI 48073-1026
Phone (248) 655-5880

Other identifiers 1

IdentifierTypeStateIssuer
1497760086MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241001000234 MI Practitioner - Qualified Speech Language Pathologist 8224569330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Recovery Project, LLCGroup PAC ID 9739154311, 33 clinicians

Practice addresses (Care Compare)

11878 Hubbard St
Livonia, MI 48150-1733
Phone (734) 953-1745

15500 19 Mile Rd
Suite 330
Clinton TWP, MI 48038-6313
Phone (586) 412-0016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7101008444MIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Recovery Project, LLC Speech-Language Pathologist CurrentSince Aug 12, 2024 Accepting new patients

Locations

15500 19 Mile Rd
Ste 330
Clinton Twp, MI 48038
Phone (586) 412-0016

11878 Hubbard St
Livonia, MI 48150
Phone (734) 953-1745

11878 Hubbard St
Ste 100
Livonia, MI 48150
Phone (734) 743-2909

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1194367292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4949 COOLIDGE HWY",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480731026",
            "telephone_number": "248-655-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11878 HUBBARD ST STE 100",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481501733",
            "telephone_number": "734-953-1745",
            "fax_number": "734-953-1743"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4949 Coolidge Hwy",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480731026",
            "country_code": "US",
            "telephone_number": "248-655-5880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEBASTIAN",
        "first_name": "JORDYN",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101008444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497760086",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.