Active NPI
Jennifer Kellams
- Speech-Language Pathologist
- Bloomington, IN
National Provider Identifier
1376940627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22005722
- Practice address
- 534 E Graham PL
Bloomington, IN 47401-4530 - Phone
- (317) 379-1209
- NPI assigned
- Dec 2, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22005722 | IN | Primary |
| Speech-Language Pathologist | 235Z00000X | SP 22380 | CA | |
| Speech-Language Pathologist | 235Z00000X | LL 60507504 | WA |
Addresses
Primary practice location
534 E Graham PL
Bloomington, IN 47401-4530
Mailing address
534 E Graham PL
Bloomington, IN 47401-4530
Phone (317) 379-1209
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SP 22380 | Other | CA | SPEECH LANGUAGE PATHOLOGY & AUDIOLOGY & HEARING AID DISPENSERS BOARD |
| LL 60507504 | Other | WA | DEPARTMENT OF HEALTH, WASHINGTON STATE |
| 22005722 | Other | IN | INDIANA PUBLIC LICENSING AGENCY, SPEECH-LANGUAGE PATHOLOGY |
Other names 1
- Jennifer Kleber
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 |
|---|---|---|---|
| SP 22380 | CA | MD | Speech-Language Pathologist |
| 22005722 | IN | MD | Speech-Language Pathologist |
| LL 60507504 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417478400000",
"number": "1376940627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "534 E GRAHAM PL",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474014530",
"telephone_number": "317-379-1209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "534 E GRAHAM PL",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474014530",
"telephone_number": "317-379-1209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLAMS",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-02",
"last_updated": "2014-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22005722",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP 22380",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL 60507504",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH LANGUAGE PATHOLOGY & AUDIOLOGY & HEARING AID DISPENSERS BOARD",
"identifier": "SP 22380",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF HEALTH, WASHINGTON STATE",
"identifier": "LL 60507504",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA PUBLIC LICENSING AGENCY, SPEECH-LANGUAGE PATHOLOGY",
"identifier": "22005722",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "KLEBER",
"credential": "CCC-SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.