Active NPI
Kseniya Naturina Fenner, CCC-SLP
- Speech-Language Pathologist
- Somerville, MA
National Provider Identifier
1376034223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 76873-SP-SL
- Practice address
- 5 Middlesex Ave
Somerville, MA 02145-1102 - Phone
- (617) 591-4657
- NPI assigned
- May 27, 2018
- 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 | 76873-SP-SL | MA | Primary |
Addresses
Primary practice location
5 Middlesex Ave
Somerville, MA 02145-1102
Mailing address
5 Middlesex Ave
Somerville, MA 02145-1102
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 |
|---|---|---|---|
| 76873-SP-SL | MA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Gate Pediatrics, a Medical Corporation | 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.
-
- Pediatrics Physician
- San Francisco, CA
- NPI 1710043039
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527379200000",
"number": "1376034223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 MIDDLESEX AVE",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021451102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 MIDDLESEX AVE",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021451102",
"telephone_number": "617-591-4657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NATURINA FENNER",
"first_name": "KSENIYA",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-27",
"last_updated": "2018-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "76873-SP-SL",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.