Jack D. Avery, CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5938 Issued in MN

Practice address

Minneapolis Vamc
1 Veterans Drive
Minneapolis, MN 55417

Phone

(612) 467-5289

Fax

(612) 467-2144

NPI assigned

Oct 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306930086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MINNEAPOLIS VAMC",
            "address_2": "1 VETERANS DRIVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55417",
            "telephone_number": "612-467-5289",
            "fax_number": "612-467-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MINNEAPOLIS VAMC",
            "address_2": "1 VETERANS DRIVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55417",
            "telephone_number": "612-467-5289",
            "fax_number": "612-467-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERY",
        "first_name": "JACK",
        "middle_name": "D.",
        "credential": "CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "5938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH PATHOLOGY LICENSE",
            "identifier": "5938",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA I.D. NUMBER",
            "identifier": "01103833",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rochelle Renee Avent-Hassan, DDS
• Avenue for Home Care, Inc
• Elena Averbakh, M.D.
• Bethel M Averbeck, MD
• Kathleen Averill, NP
• Jacquelyn Avery, PHD
• Max Avery, MA, LPCC, LADC
• Melissa Dodds Avery, CNM PHD
• Aviation ABA Therapy MN LLC
• Avid Behavior Health Services

• Speech-Language Pathologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.