Active NPI
Jack King
- Speech-Language Pathologist
- Duluth, MN
National Provider Identifier
1649811902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7926
- Practice address
- 2501 Rice Lake Rd
Duluth, MN 55811-4819 - Phone
- (218) 625-6400
- NPI assigned
- Oct 7, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | 7926 | MN | Primary |
Addresses
Primary practice location
2501 Rice Lake Rd
Duluth, MN 55811-4819
Mailing address
810 1St St
Proctor, MN 55810-2705
Phone (218) 341-5513
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 |
|---|---|---|---|
| 7926 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570406400000",
"number": "1649811902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 1ST ST",
"city": "PROCTOR",
"state": "MN",
"postal_code": "558102705",
"telephone_number": "218-341-5513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 RICE LAKE RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558114819",
"telephone_number": "218-625-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "JACK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-07",
"last_updated": "2019-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "7926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.