Active NPI
Jessica M. Logan, M.S., CCC-SLP, TSLD
- Speech-Language Pathologist
- North Chili, NY
National Provider Identifier
1306179742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 019242-1
- Practice address
- 3 Springbrook Dr
North Chili, NY 14514-1220 - Phone
- (585) 208-2192
- NPI assigned
- Sep 17, 2009
- 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 Pathologist | 235Z00000X | 019242-1 | NY | Primary |
Addresses
Primary practice location
3 Springbrook Dr
North Chili, NY 14514-1220
Mailing address
3 Springbrook Dr
North Chili, NY 14514-1220
Phone (585) 208-2192
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30-0213081 | Other | NY | TAX ID |
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019242-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453766400000",
"number": "1306179742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 SPRINGBROOK DR",
"city": "NORTH CHILI",
"state": "NY",
"postal_code": "145141220",
"telephone_number": "585-208-2192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 SPRINGBROOK DR",
"city": "NORTH CHILI",
"state": "NY",
"postal_code": "145141220",
"telephone_number": "585-208-2192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "JESSICA",
"middle_name": "M.",
"credential": "M.S., CCC-SLP, TSLD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-17",
"last_updated": "2016-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "019242-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "30-0213081",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Chili, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.