Jessica Niederkorn, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP005748 Issued in GA

Practice address

4034 Roundtop Cir
Perry, GA 31069-7806

Phone

(478) 718-0573

NPI assigned

Aug 15, 2005

Reactivated

Apr 12, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• The Speech Path

  • Speech-Language Pathologist
  • Perry, GA
  • NPI 1487011888
  NPD (past)
• The Speech Path LLC

  • Speech-Language Pathologist
  • Macon, GA
  • NPI 1477950533
  NPD (past)
• The Speech Path, LLC

  • Speech-Language Pathologist
  • Macon, GA
  • NPI 1922320373
  NPD (past)

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1366444846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4034 ROUNDTOP CIR",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310697806",
            "telephone_number": "478-718-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4034 ROUNDTOP CIR",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310697806",
            "telephone_number": "478-718-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEDERKORN",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-15",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "deactivation_date": "2006-03-22",
        "reactivation_date": "2006-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP005748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639235193K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myeyedr Optometry of Georgia, LLC
• N.T. Cardiovascular Center, PC
• Lauren K Nadekow, CCC-SLP
• Neuronest ABA
• New Pointe Treatment Center
• Jepthe Nkwanmen, RN
• Obstetrics of Perry, PC
• Melissa Terry Olah, PA-C
• Marietta Pana Olaivar-Lomboy, NP
• Mary Ann Orr, M.ED. CCC-SLP

• Speech-Language Pathologist in Perry, GA
• Providers in Perry, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.