Active NPI
Jiwon Kim
- Speech-Language Pathologist
- Worcester, MA
National Provider Identifier
1245113083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP101789
- Practice address
- 55 Lake Ave N
Worcester, MA 01655-0002 - Phone
- (774) 442-4022
- NPI assigned
- Jul 29, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
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 | SLP101789 | MA | Primary |
Addresses
Primary practice location
55 Lake Ave N
Worcester, MA 01655-0002
Mailing address
465 Meadow Rd Apt 8203
Princeton, NJ 08540-6361
Phone (314) 489-5332
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 |
|---|---|---|---|
| SLP101789 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753747200000",
"number": "1245113083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "465 MEADOW RD APT 8203",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085406361",
"telephone_number": "314-489-5332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 LAKE AVE N",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016550002",
"telephone_number": "774-442-4022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIWON",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-07-29",
"last_updated": "2025-07-29",
"certification_date": "2025-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "SLP101789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.