Scott Bryan Jackson, M.S., CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

016099-1 Issued in NY

Practice address

235 Blue Point Ave
Little Angels Center
Blue Point, NY 11715-1203

Phone

(631) 363-5794

Fax

(631) 363-8046

NPI assigned

Jan 24, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Little Angels Center, Inc

  • Speech-Language Pathologist
  • Medford, NY
  • NPI 1588719041
  NPD (past)

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356496707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 BLUE POINT AVE",
            "address_2": "LITTLE ANGELS CENTER",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151203",
            "telephone_number": "631-363-5794",
            "fax_number": "631-363-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 BLUE POINT AVE",
            "address_2": "LITTLE ANGELS CENTER",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151203",
            "telephone_number": "631-363-5794",
            "fax_number": "631-363-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SCOTT",
        "middle_name": "BRYAN",
        "credential": "M.S., CCC SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "016099-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Hylton Maule, LPN
• Gionna Marie Ianne
• Kristina Iglanova
• Melanie Intemann, RN, BSN
• Brittany Ivory
• Jenny Jacques
• Roneeja Danalle James, LPN
• Alicia Johnson, LPN
• Jasmine Elaine Layug Jones
• Jennifer Joniak, M.A., SLP

• Speech-Language Pathologist in Blue Point, NY
• Providers in Blue Point, NY by specialty
• Speech-Language Pathologist in New York

• 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.