Active NPI
Rosemarie B Van Der Jagt, M.A. CCC-SLP
- Speech-Language Pathologist
- Redding, CA
National Provider Identifier
1376852582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18563
- Practice address
- 2120 Benton Dr
Redding, CA 96003-2151 - Phone
- (530) 243-6317
- NPI assigned
- Oct 5, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 18563 | CA | Primary |
Addresses
Primary practice location
2120 Benton Dr
Redding, CA 96003-2151
Mailing address
20 Saxony Rd
Pittsford, NY 14534-3050
Phone (585) 727-6923
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18563 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337212800000",
"number": "1376852582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 SAXONY RD",
"city": "PITTSFORD",
"state": "NY",
"postal_code": "145343050",
"telephone_number": "585-727-6923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 BENTON DR",
"city": "REDDING",
"state": "CA",
"postal_code": "960032151",
"telephone_number": "530-243-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DER JAGT",
"first_name": "ROSEMARIE",
"middle_name": "B",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-05",
"last_updated": "2012-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "18563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.