Active NPI
Katelynn Jagodzinski
- Athletic Trainer
- South Salem, NY
National Provider Identifier
1285058297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 001678-1
- Practice address
- 12 Laurie LN
South Salem, NY 10590-1700 - Phone
- (845) 625-4614
- NPI assigned
- Feb 11, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 001678-1 | NY | Primary |
| Athletic Trainer | 2255A2300X | 000533 | CT |
Addresses
Primary practice location
12 Laurie LN
South Salem, NY 10590-1700
Mailing address
12 Laurie LN
South Salem, NY 10590-1700
Phone (845) 625-4614
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 |
|---|---|---|---|
| 000533 | CT | MD | Mental Health Counselor |
| 001678-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392076800000",
"number": "1285058297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 LAURIE LN",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105901700",
"telephone_number": "845-625-4614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 LAURIE LN",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105901700",
"telephone_number": "845-625-4614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAGODZINSKI",
"first_name": "KATELYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-11",
"last_updated": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "001678-1",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "000533",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salem, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.