Jennifer Vidal, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

77234 Issued in MA

Practice address

5 Middlesex Ave
Somerville, MA 02145-1102

Phone

(617) 591-4602

NPI assigned

Jan 5, 2018

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

• Jennifer Trubin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jtrubin96883@direct.challiance.masshiway.net

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.

• Cambridge Public Health Commission

  • General Acute Care Hospital
  • Cambridge, MA
  • NPI 1487603585
  NPD

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1568979011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 D ST UNIT 316",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022101943",
            "telephone_number": "908-399-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MIDDLESEX AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451102",
            "telephone_number": "617-591-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "JENNIFER",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "77234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "TRUBIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marissa Ventre, M.A., L.M.H.C.
• Peter Blaine Ventre
• Kendia Vertus
• Alexis Vichniac
• Napoleon Vinicio Vicioso
• Julie Vigneault, DMD
• Arturo Villarreal-Verdecia, MD
• Libby Vilner
• Sanjeevan Virk, D.M.D.
• Alexandra Viscosi

• Speech-Language Pathologist in Somerville, MA
• Providers in Somerville, MA by specialty
• Speech-Language Pathologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.