Active NPI
Amanda Patricia Wallace
- Speech-Language Assistant
- Sacramento, CA
National Provider Identifier
1245611243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 2945
- Practice address
- 2115 J St Ste 210
Sacramento, CA 95816-4734 - Phone
- (916) 444-0033
- NPI assigned
- Jun 16, 2015
- Sex
- Female
- 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 Assistant | 2355S0801X | 2945 | CA | Primary |
Addresses
Primary practice location
2115 J St Ste 210
Sacramento, CA 95816-4734
Mailing address
4850 Natomas Blvd Apt 127
Sacramento, CA 95835-1266
Phone (310) 800-7647
Other practice location 1
11840 S La Cienega Blvd
Hawthorne, CA 90250-3459
Phone (424) 269-3400
Other practice location 2
249 E Ocean Blvd Ste 400
Long Beach, CA 90802-4806
Phone (888) 808-7838
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 |
|---|---|---|---|
| 2945 | CA | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Jade & Associates, a Speech Pathology Corporation | Past | Accepting new patients |
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.
-
dba Jackson Jade Speech, Occupational & Physical Therapy
- Speech-Language Pathologist
- Franklin, TN
- NPI 1639305014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1245611243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4850 NATOMAS BLVD APT 127",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958351266",
"telephone_number": "310-800-7647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 J ST STE 210",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958164734",
"telephone_number": "916-444-0033"
}
],
"practiceLocations": [
{
"address_1": "11840 S La Cienega Blvd",
"address_purpose": "LOCATION",
"city": "Hawthorne",
"state": "CA",
"postal_code": "902503459",
"country_code": "US",
"telephone_number": "424-269-3400",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "249 E Ocean Blvd Ste 400",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "CA",
"postal_code": "908024806",
"country_code": "US",
"telephone_number": "888-808-7838",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "AMANDA PATRICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-16",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "CA",
"license": "2945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.