Individual provider Active NPI

Jennifer McDonald, MS, CCC-SLP

  • Speech-Language Pathologist
  • Towson, MD
National Provider Identifier
1588052195
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA16569 Issued in FL
Practice address
6901 N Charles St
Towson, MD 21204-3780
Phone
(321) 794-5390
NPI assigned
Jan 5, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA16569 FL Primary

Addresses

Primary practice location

6901 N Charles St
Towson, MD 21204-3780

Mailing address

6901 N Charles St
Towson, MD 21204-3780

Other practice location 1

1420 Oak St
Melbourne, FL 32901-3113
Phone (321) 723-3215

Other practice location 2

760 North Dr Ste D
Melbourne, FL 32934-9247
Phone (321) 254-4254

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SA16569FLMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1588052195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 N CHARLES ST",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212043780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 N CHARLES ST",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212043780",
            "telephone_number": "321-794-5390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 Oak St",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013113",
            "country_code": "US",
            "telephone_number": "321-723-3215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "760 North Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329349247",
            "country_code": "US",
            "telephone_number": "321-254-4254",
            "fax_number": "321-254-6269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "JENNIFER",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-05",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA16569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.

Verify at the official NPI Registry.