Active NPI
Jacquelyn Suzanne Lavender, SLP
- Speech-Language Pathologist
- Duluth, GA
National Provider Identifier
1538879010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP005556
- Practice address
- 8770 Glasgow Pointe
Duluth, GA 30097-6606 - Phone
- (440) 497-8499
- NPI assigned
- Nov 25, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | SLP005556 | GA | Primary |
Addresses
Primary practice location
8770 Glasgow Pointe
Duluth, GA 30097-6606
Mailing address
2746 Berkshire Dr
Winder, GA 30680-6121
Phone (770) 362-6939
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bhanja Enterprises LLC | Single Specialty | Current | Accepting new patients |
Organizations & group practices 1
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": "1669334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669334400000",
"number": "1538879010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2746 BERKSHIRE DR",
"city": "WINDER",
"state": "GA",
"postal_code": "306806121",
"telephone_number": "770-362-6939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8770 GLASGOW POINTE",
"city": "DULUTH",
"state": "GA",
"postal_code": "300976606",
"telephone_number": "440-497-8499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVENDER",
"first_name": "JACQUELYN",
"middle_name": "SUZANNE",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-25",
"last_updated": "2022-11-25",
"certification_date": "2022-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP005556",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.