Active NPI
Jacob Lee
- Speech-Language Pathologist
- Carson City, NV
National Provider Identifier
1528895869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP-4019
- Practice address
- 3427 Goni Rd Ste 104
Carson City, NV 89706-7972 - Phone
- (702) 251-0111
- NPI assigned
- Sep 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP-4019 | NV | Primary |
Addresses
Primary practice location
3427 Goni Rd Ste 104
Carson City, NV 89706-7972
Mailing address
445 Kensington Ave
Missoula, MT 59801-5723
Phone (406) 214-8308
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-4019 | NV | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1528895869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 KENSINGTON AVE",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598015723",
"telephone_number": "406-214-8308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3427 GONI RD STE 104",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897067972",
"telephone_number": "702-251-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-19",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NV",
"license": "SP-4019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.