Individual provider Active NPI

Genesis Ashlee Mystique McLaren

  • Speech-Language Pathologist
  • Plainview, NY
National Provider Identifier
1215744966
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
255 Executive Dr Ste Ll108
Plainview, NY 11803-1707
Phone
(516) 576-2040
NPI assigned
Dec 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 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 NY Primary

Addresses

Primary practice location

255 Executive Dr Ste Ll108
Plainview, NY 11803-1707

Mailing address

1536 Westervelt Ave
North Baldwin, NY 11510-1648
Phone (516) 435-0078

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

NPI Registry JSON

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1215744966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 WESTERVELT AVE",
            "city": "NORTH BALDWIN",
            "state": "NY",
            "postal_code": "115101648",
            "telephone_number": "516-435-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 EXECUTIVE DR STE LL108",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118031707",
            "telephone_number": "516-576-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLAREN",
        "first_name": "GENESIS",
        "middle_name": "ASHLEE MYSTIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainview, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; 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.