Active NPI
Jessica Lyn Gibbons, M.A. CCC-SLP
- Speech-Language Pathologist
- Tannersville, PA
National Provider Identifier
1356517460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 2937 Route 611 Unit 15
Tannersville, PA 18372-6000 - Phone
- (570) 236-8380
- Fax
- (570) 355-4097
- NPI assigned
- May 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Feeding, Eating & Swallowing Occupational Therapist | 225XF0002X | |||
| Pediatric Occupational Therapist | 225XP0200X | |||
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
2937 Route 611 Unit 15
Tannersville, PA 18372-6000
Mailing address
1932 Kirtley CT
Blakeslee, PA 18610-7911
Phone (570) 236-8380
Other practice location 1
1932 Kirtley Ct
Blakeslee, PA 18610-7911
Phone (570) 236-8380
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 Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sugar Plum Speech LLC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
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": "1210204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539216000000",
"number": "1356517460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1932 KIRTLEY CT",
"city": "BLAKESLEE",
"state": "PA",
"postal_code": "186107911",
"telephone_number": "570-236-8380",
"fax_number": "570-355-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2937 ROUTE 611 UNIT 15",
"city": "TANNERSVILLE",
"state": "PA",
"postal_code": "183726000",
"telephone_number": "570-236-8380",
"fax_number": "570-355-4097"
}
],
"practiceLocations": [
{
"address_1": "1932 Kirtley Ct",
"address_purpose": "LOCATION",
"city": "Blakeslee",
"state": "PA",
"postal_code": "186107911",
"country_code": "US",
"telephone_number": "570-236-8380",
"fax_number": "570-355-4097",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GIBBONS",
"first_name": "JESSICA",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-08",
"last_updated": "2018-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "225XF0002X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist, Feeding, Eating & Swallowing",
"state": null,
"license": null,
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tannersville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.