Individual provider Active NPI

Jessica Amedeo-Johnson, SLP

  • Speech-Language Pathologist
  • Salt Lake City, UT
National Provider Identifier
1619001856
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP4134 Issued in AZ
Practice address
1952 Fort Union Blvd
Salt Lake City, UT 84121-6877
Phone
(801) 942-3311
NPI assigned
Mar 16, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 SLP4134 AZ Primary

Addresses

Primary practice location

1952 Fort Union Blvd
Salt Lake City, UT 84121-6877

Mailing address

1952 Fort Union Blvd Ste 100
Salt Lake City, UT 84121-6878
Phone (801) 942-3311

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

LicenseStateTypeSpecialty
SLP4134AZMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619001856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 FORT UNION BLVD STE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216878",
            "telephone_number": "801-942-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 FORT UNION BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216877",
            "telephone_number": "801-942-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEDEO-JOHNSON",
        "first_name": "JESSICA",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP4134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.