Jennifer Gornto Lake, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

109643 Issued in TX

Practice address

16400 Blanco Rd
San Antonio, TX 78232-1902

Phone

(210) 540-8288

NPI assigned

Sep 28, 2023

Last updated

Sep 28, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rise Up Rehab, LLCGroup PAC ID 3274861497, 118 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rise Up Rehab, LLC

  • Rehabilitation Clinic/Center
  • San Antonio, TX
  • NPI 1962054858

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1396524286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16400 BLANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321902",
            "telephone_number": "210-540-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16400 BLANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321902",
            "telephone_number": "210-540-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JENNIFER",
        "middle_name": "GORNTO",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-28",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "109643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laith Family Dentristry
• Aleena Laitos
• Brooke Aileen Lajeunesse, MD
• Lake Area Home Health, LLC (Choice Health at Home)
• Lake Mi Mobile Doctors PC (Mobile Doctors of San Antonio)
• Lakesh Allure, PLLC
• Lakeside ABA TX LLC
• Lakeside Med PLLC
• Lakewood Senior Living of Alta Vista LLC (Lakewood Senior Living of Alta Vista)
• Katherine Lyn Lakey, MD

• Speech-Language Pathologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.