Shane James, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

284413-4102-20150323 Issued in UT

Practice address

425 Medical Dr Ste 122
Bountiful, UT 84010

Phone

(801) 719-0754

Fax

(385) 275-6764

NPI assigned

Apr 15, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Summit Speech Therapy

  • Speech-Language Pathologist
  • Bountiful, UT
  • NPI 1710344973
  NPD (past)

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526947200000",
    "number": "1629464706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MEDICAL DR STE 122",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104956",
            "telephone_number": "801-719-0754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 MEDICAL DR STE 122",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "801-719-0754",
            "fax_number": "385-275-6764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMES",
        "first_name": "SHANE",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2018-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "UT",
            "license": "284413-4102-20150323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Jacobson, D.O.
• Kelsey Jacobson
• Shanna Joy Jaggers
• James E Russon DDS PC
• James H. Martineau, DMD, PLLC
• Launee Lyn Janes, COTA
• Jared J Tyson MD PC
• Carmela J Javellana, MD
• Garrett Tanner Jefferies
• Jeffery R. Oka, M.D., P.C.

• Speech-Language Pathologist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Speech-Language Pathologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.