Active NPI
Jessica Wittbrodt
- Speech-Language Pathologist
- Indianapolis, IN
National Provider Identifier
1366788861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 462002333A
- Practice address
- 4920 Encore Dr
Apt 11
Indianapolis, IN 46237-2593 - Phone
- (317) 494-5097
- NPI assigned
- Jan 2, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 462002333A | IN | Primary |
Addresses
Primary practice location
4920 Encore Dr
Apt 11
Indianapolis, IN 46237-2593
Mailing address
4920 Encore Dr
Apt 11
Indianapolis, IN 46237-2593
Phone (317) 494-5097
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 462002333A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1366788861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4920 ENCORE DR",
"address_2": "APT 11",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462372593",
"telephone_number": "317-494-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4920 ENCORE DR",
"address_2": "APT 11",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462372593",
"telephone_number": "317-494-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTBRODT",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-02",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "462002333A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.