Individual provider Active NPI

Jennifer A Kellogg-Smith, MA CCC-SLP

  • Speech-Language Pathologist
  • Issaquah, WA
National Provider Identifier
1306025515
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
LL00003561 Issued in WA
Practice address
710 NW Juniper St
Suite 108
Issaquah, WA 98027-2717
Phone
(425) 392-4965
Fax
(425) 391-2555
NPI assigned
Oct 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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 LL00003561 WA Primary

Addresses

Primary practice location

710 NW Juniper St
Suite 108
Issaquah, WA 98027-2717

Mailing address

710 NW Juniper St
Suite 108
Issaquah, WA 98027-2717
Phone (425) 392-4965

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LL00003561WAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Susan L. Cohn & Associates Speech-Language Pathologist 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.

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1306025515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 NW JUNIPER ST",
            "address_2": "SUITE 108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272717",
            "telephone_number": "425-392-4965",
            "fax_number": "425-391-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 NW JUNIPER ST",
            "address_2": "SUITE 108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272717",
            "telephone_number": "425-392-4965",
            "fax_number": "425-391-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLOGG-SMITH",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-24",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL00003561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.