Jessamyn Nichols, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

085663 Issued in IA

Practice address

217 E Bremer Ave
Waverly, IA 50677-3435

Phone

(319) 352-4544

NPI assigned

Jun 22, 2021

Last updated

Jun 25, 2021By 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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fox Rehab SLP Ia PLLCGroup PAC ID 3870970486, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fox Rehab SLP Ia PLLC

  • Speech-Language Pathologist
  • Norwalk, IA
  • NPI 1427719947
  Medicare reassignment Care Compare group NPD
• Blue Stone Therapy Inc.

  • Physical Medicine & Rehabilitation Physician
  • Urbandale, IA
  • NPI 1932797297
  Medicare reassignment NPD

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1316516412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E BREMER AVE",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506773435",
            "telephone_number": "319-352-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E BREMER AVE",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506773435",
            "telephone_number": "319-352-4544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Park Ln",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IA",
            "postal_code": "507025200",
            "country_code": "US",
            "telephone_number": "319-291-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JESSAMYN",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "085663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "665992",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "optimahcs.com",
            "affiliation": "N",
            "address_1": "217 E Bremer Ave",
            "city": "Waverly",
            "state": "IA",
            "country_code": "US",
            "postal_code": "506773435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacob Nagel, PA-C
• Brian C Nedoba, LISW
• Natalie Joy Nedza
• Eric L Newsom, OTR/L
• Stephanie Newsom, MA,LMHC, NCC
• Alexandria Marie Nicholson, OTR
• James Robert Nielcen, R.PH.
• Abigail L Nieman
• Kristina Nikl
• Tina Lynn Noble, MPT

• Speech-Language Pathologist in Waverly, IA
• Providers in Waverly, IA by specialty
• Speech-Language Pathologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.