Individual provider Active NPI

Jenifer Ownby, M.E., C.C.C.

  • Speech-Language Pathologist
  • Brandon, FL
National Provider Identifier
1629168554
Registry record updated Apr 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA2396 Issued in FL
Practice address
602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Phone
(813) 653-1149
Fax
(813) 654-6644
NPI assigned
Oct 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X
Speech-Language Pathologist 235Z00000X SA2396 FL Primary

Addresses

Primary practice location

602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900

Mailing address

602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Phone (813) 653-1149

Other identifiers 3

IdentifierTypeStateIssuer
811981300MedicaidFL
881402300MedicaidFL
S1410OtherFLBC/BS OF FLORIDA #

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 Engineering

State licenses

LicenseStateTypeSpecialty
SA2396FLMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303084800000",
    "number": "1629168554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 VONDERBURG DR",
            "address_2": "SUITE 201",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115900",
            "telephone_number": "813-653-1149",
            "fax_number": "813-654-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 VONDERBURG DR",
            "address_2": "SUITE 201",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115900",
            "telephone_number": "813-653-1149",
            "fax_number": "813-654-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWNBY",
        "first_name": "JENIFER",
        "name_prefix": "Mrs.",
        "credential": "M.E., C.C.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA2396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "811981300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "881402300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF FLORIDA #",
            "identifier": "S1410",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; 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.