Active NPI
Jade Champagne Reynolds
- Speech-Language Pathologist
- Davie, FL
National Provider Identifier
1659703338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SZ6305
- Practice address
- 12545 Orange Dr
Suite 502
Davie, FL 33330-4306 - Phone
- (954) 474-8048
- Fax
- (954) 474-8145
- NPI assigned
- Aug 5, 2013
- Sex
- Female
- 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 | SZ6305 | FL | Primary |
Addresses
Primary practice location
12545 Orange Dr
Suite 502
Davie, FL 33330-4306
Mailing address
4501 NW 85TH Ave
Coral Springs, FL 33065-1321
Phone (954) 298-1379
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 |
|---|---|---|---|
| SZ6305 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1659703338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 NW 85TH AVE",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330651321",
"telephone_number": "954-298-1379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12545 ORANGE DR",
"address_2": "SUITE 502",
"city": "DAVIE",
"state": "FL",
"postal_code": "333304306",
"telephone_number": "954-474-8048",
"fax_number": "954-474-8145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JADE",
"middle_name": "CHAMPAGNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-05",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SZ6305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.