Kelly Renee Jacobs- Belodeau

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

19679 Issued in CA

Practice address

47774 Brawner PL
Potomac Falls, VA 20165-4708

Phone

(703) 629-9248

NPI assigned

Aug 17, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1558816702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47774 BRAWNER PL",
            "city": "POTOMAC FALLS",
            "state": "VA",
            "postal_code": "201654708",
            "telephone_number": "703-629-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47774 BRAWNER PL",
            "city": "POTOMAC FALLS",
            "state": "VA",
            "postal_code": "201654708",
            "telephone_number": "703-629-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS- BELODEAU",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "19679",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202004176",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eunju Yang Hernandez, CRNP-FAMILY
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• William Richard Jackomis, D.D.S., J.D.
• Karma Home Health Care LLC
• Jeffrey L Kent, DO
• Kaitlin Mae Kersey, FNP
• Tarek Khalil, OD
• Kidsfirst Pediatrics, PLLC

• Speech-Language Pathologist in Potomac Falls, VA
• Providers in Potomac Falls, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.