Jessica Rose Wenzl, MA CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

13215 Issued in OR

Practice address

17727 E Burnside St
Suite B
Portland, OR 97233-4803

Phone

(503) 215-9800

NPI assigned

Nov 21, 2006

Last updated

Oct 17, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miss Jessica Rose Croson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350432000000",
    "number": "1255406005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5523 SE GLADSTONE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972063971",
            "telephone_number": "503-490-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17727 E BURNSIDE ST",
            "address_2": "SUITE B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972334803",
            "telephone_number": "503-215-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENZL",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "MA CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2012-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "13215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "0663623",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSP000390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CROSON",
            "middle_name": "ROSE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sally J Wentross, MD
• Daniel Wentz
• James Bond Wentzien, M.D.
• Wesley Wenzel, PA-C
• Lauren M Wenzinger
• Lauren Wepprich, MSW
• Jeffrey Joseph Weprin, MD
• Jennifer Ann Werden-Gillaspie
• Scott David Werden, D.O.
• Todd Werkhoven

• Speech-Language Pathologist in Portland, OR
• Providers in Portland, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.