Jillian Marie Fonseca, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

028995 Issued in NY

Practice address

227 East 41St Street
8TH Floor
New York, NY 10017-1001

Phone

(212) 273-6100

Fax

(212) 273-6427

NPI assigned

Sep 4, 2019

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

Other names 1

• Jillian Marie Thelen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Interoperability endpoints

• Direct secure messaging: jillian.thelen.p1@direct.premierhealthcare.nextgenshare.com

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.

• Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1760436190
  NPD (past)
• Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1831330182
  NPD (past)

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1508415472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 CRESTWOOD LN",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070662640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 EAST 41ST STREET",
            "address_2": "8TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100171001",
            "telephone_number": "212-273-6100",
            "fax_number": "212-273-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "JILLIAN",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-04",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "028995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "THELEN",
            "middle_name": "MARIE",
            "credential": "SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ngoanu Empero Fonkem
• Surgein I Fonollosa, LMSW
• Maria Camila Fonseca Mora, MD
• Amanda Fonseca, COTA/L
• Elisabeth R Fonseca, PHD
• Jose Luis Fonseca, CRPA-P
• Juan Pablo Fonseca, M. D.
• Victoria Isabella Fonseca
• Valeria Eugenia Font Zorrilla
• Andrew W Fontaine

• Speech-Language Pathologist in New York, NY
• Providers in New York, 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 May 8, 2020; 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.