Individual provider Active NPI

Jessica George, SLP

  • Speech-Language Pathologist
  • McKinney, TX
National Provider Identifier
1477867125
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
105094 Issued in TX
Practice address
12012 Bonifay CT
McKinney, TX 75071
Phone
(214) 566-2687
Fax
(866) 323-1955
NPI assigned
Aug 4, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 105094 TX Primary

Addresses

Primary practice location

12012 Bonifay CT
McKinney, TX 75071

Mailing address

12012 Bonifay CT
McKinney, TX 75071-8624
Phone (214) 536-4190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240820001262 TX Practitioner - Qualified Speech Language Pathologist 2466990577 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Myo Fun Speech Plus Speech-Language Pathologist CurrentSince Aug 6, 2024 Accepting new patients
Most Therapy Speech-Language Pathologist Past Accepting new patients

Locations

4601 Medical Center Dr
Ste AC1
McKinney, TX 75069
Phone (469) 850-2909

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1477867125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12012 BONIFAY CT",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750718624",
            "telephone_number": "214-536-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12012 BONIFAY CT",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "75071",
            "telephone_number": "214-566-2687",
            "fax_number": "866-323-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "JESSICA",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-04",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "105094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.