Individual provider Active NPI

Jeannie Irvine Henriques

  • Speech-Language Pathologist
  • Wilmington, DE
National Provider Identifier
1205236148
Registry record updated Aug 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
O1-0001395 Issued in DE
Practice address
99 Middleboro Rd
Wilmington, DE 19804
Phone
(302) 992-5574
NPI assigned
Aug 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2014

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 O1-0001395 DE Primary

Addresses

Primary practice location

99 Middleboro Rd
Wilmington, DE 19804

Mailing address

99 Middleboro Rd
Wilmington, DE 19804
Phone (302) 992-5574

Other identifiers 1

IdentifierTypeStateIssuer
1861528648MedicaidDE

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

LicenseStateTypeSpecialty
O1-0001395DEMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409184000000",
    "number": "1205236148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 MIDDLEBORO RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19804",
            "telephone_number": "302-992-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 MIDDLEBORO RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19804",
            "telephone_number": "302-992-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIQUES",
        "first_name": "JEANNIE",
        "middle_name": "IRVINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-28",
        "last_updated": "2014-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "DE",
            "license": "O1-0001395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861528648",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.