Active NPI
Kemberlee J Jack, CCC-SLP
- Speech-Language Pathologist
- Houston, TX
National Provider Identifier
1609165505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 115500
- Practice address
- 16562 Beckland LN
Houston, TX 77084-6541 - Phone
- (214) 519-4984
- NPI assigned
- Mar 31, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 35825 | TX | |
| Speech-Language Pathologist | 235Z00000X | SLP010119 | GA | |
| Speech-Language Pathologist | 235Z00000X | 8201 | LA | |
| Speech-Language Pathologist | 235Z00000X | 115500 | TX | Primary |
Addresses
Primary practice location
16562 Beckland LN
Houston, TX 77084-6541
Mailing address
16562 Beckland LN
Houston, TX 77084-6541
Phone (214) 519-4984
Other practice location 1
1241 Shadybrook Dr
Baton Rouge, LA 70816-1273
Phone (337) 308-5565
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 |
|---|---|---|---|
| 8201 | LA | MD | Professional Counselor |
| 35825 | TX | MD | Speech-Language Assistant |
| SLP010119 | GA | MD | Speech-Language Pathologist |
| 115500 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620691200000",
"number": "1609165505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16562 BECKLAND LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770846541",
"telephone_number": "214-519-4984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16562 BECKLAND LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770846541",
"telephone_number": "214-519-4984"
}
],
"practiceLocations": [
{
"address_1": "1241 Shadybrook Dr",
"address_purpose": "LOCATION",
"city": "Baton Rouge",
"state": "LA",
"postal_code": "708161273",
"country_code": "US",
"telephone_number": "337-308-5565",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACK",
"first_name": "KEMBERLEE",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-31",
"last_updated": "2021-05-11",
"certification_date": "2021-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "TX",
"license": "35825",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP010119",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "8201",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "115500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.