Jennifer Rae Phillips, MS, CCC-SLP/L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

013565-1 Issued in NY

Practice address

774 Fairmount Ave
Jamestown, NY 14701-2609

Phone

(716) 338-0668

Fax

(866) 694-4979

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Jennifer Rae Greene Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453766400000",
    "number": "1477567675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 FAIRMOUNT AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147012609",
            "telephone_number": "716-338-0668",
            "fax_number": "866-694-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 FAIRMOUNT AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147012609",
            "telephone_number": "716-338-0668",
            "fax_number": "866-694-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JENNIFER",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2016-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "02324358",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "013565-1",
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02324358",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GREENE",
            "middle_name": "RAE",
            "credential": "MS, CCC-SLP/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hunter Peterson
• Jacquelyn Peterson
• Lauraine Alice Peterson
• Michael Carl Peterson, P.T.
• Nikki Michele Peterson, CNM
• Anne Piazza, SOCIAL WORKER
• Krissy Ann Piazza, LPN
• Shelley Lynn Piazza, RPH
• Dawn M Pickett, MSN, RN
• June Elaine Piede, SLP

• Speech-Language Pathologist in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.