Active NPI
Nicole Louise McKinnon, M.S, CCC-SLP
- Speech-Language Pathologist
- Syracuse, NY
National Provider Identifier
1639440654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 021628-1
- Practice address
- 1744 W Genesee St
Syracuse, NY 13204-1902 - Phone
- (315) 468-3414
- NPI assigned
- Jan 23, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 021628-1 | NY | Primary |
Addresses
Primary practice location
1744 W Genesee St
Syracuse, NY 13204-1902
Mailing address
310 Stillwell Cir
East Syracuse, NY 13057-1624
Phone (845) 807-2066
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021628-1 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syracuse University | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Audiologist
- Syracuse, NY
- NPI 1558339473
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484092800000",
"number": "1639440654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 STILLWELL CIR",
"city": "EAST SYRACUSE",
"state": "NY",
"postal_code": "130571624",
"telephone_number": "845-807-2066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1744 W GENESEE ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132041902",
"telephone_number": "315-468-3414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINNON",
"first_name": "NICOLE",
"middle_name": "LOUISE",
"credential": "M.S, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-23",
"last_updated": "2017-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "021628-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.