Individual provider Active NPI

Vanessa Gillogly

  • Speech-Language Pathologist
  • State College, PA
National Provider Identifier
1346793171
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SL013941 Issued in PA
Practice address
1950 Cliffside Dr
State College, PA 16801-7662
Phone
(814) 238-3139
NPI assigned
Jul 28, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SD
Speech-Language Pathologist 235Z00000X SL013941 PA Primary

Addresses

Primary practice location

1950 Cliffside Dr
State College, PA 16801-7662

Mailing address

1950 Cliffside Dr
State College, PA 16801-7662

Other practice location 1

920 W King St
Spearfish, SD 57783-1300
Phone (605) 717-1205

Other identifiers 1

IdentifierTypeStateIssuer
14172050MedicaidSD

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
SL013941PAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Select Rehabilitation, LLC Speech-Language Pathologist CurrentSince Apr 2, 2022 Accepting new patients
Empowerme Rehabilitation, LLC Speech-Language Pathologist CurrentSince Mar 4, 2024 Accepting new patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Oct 8, 2024 Accepting new patients
Empowerme Rehabilitation, LLC Speech-Language Pathologist CurrentSince Mar 4, 2024 Accepting new patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Oct 8, 2024 Accepting new patients

Locations

13391 N 94th Dr
Peoria, AZ 85381
Phone (623) 232-9841

13822 S 46th Pl
Phoenix, AZ 85044
Phone (480) 598-1224

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

110 Horizon Dr
#310
Raleigh, NC 27615

Organizations & group practices 5

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": "1469664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1346793171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 CLIFFSIDE DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 CLIFFSIDE DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017662",
            "telephone_number": "814-238-3139"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 W King St",
            "address_purpose": "LOCATION",
            "city": "Spearfish",
            "state": "SD",
            "postal_code": "577831300",
            "country_code": "US",
            "telephone_number": "605-717-1205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLOGLY",
        "first_name": "VANESSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-28",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SD",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL013941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14172050",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.