Jared Austin Fulgham, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9451387-4102 Issued in UT

Practice address

6410 Old Main HL
Logan, UT 84322-6410

Phone

(435) 797-1375

Fax

(844) 308-5865

NPI assigned

Jun 25, 2019

Sex

Male

Sole proprietor

No

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.

• Utah State University

  • Audiologist
  • Logan, UT
  • NPI 1235374984
  Medicare reassignment Care Compare group NPD Speech-Language Pathologist, UT
• Utah State University

  • Developmental Disabilities Clinic/Center
  • Logan, UT
  • NPI 1174694095
  NPD
• Utah State University

  • Specialist
  • Logan, UT
  • NPI 1447715701
  NPD
• Usu Student Health & Wellness

  • Health Service Clinic/Center
  • Logan, UT
  • NPI 1992170443
  NPD (past)

Specialty

Qualified Speech Language Pathologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah State University 10 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in UT

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 25, 2019.

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1659932275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843226410",
            "telephone_number": "435-797-1375",
            "fax_number": "844-308-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843226410",
            "telephone_number": "435-797-1375",
            "fax_number": "844-308-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULGHAM",
        "first_name": "JARED",
        "middle_name": "AUSTIN",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "UT",
            "license": "9451387-4102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9451387-4102",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "SLP-3236",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brock Freidenberger, PMHNP
• Telesha Lee Fricke, MA, CCC-SLP
• Kaye W Frost
• Kenneth Douglas Fryer, D.D.S., M.S.
• Daria Griffith Fuell
• Caley Jean Fuller
• Maku Moana Maree Fullmer, LAMFT
• Bennita J Gage, CPM, LDEM
• Kathryn S Gantz, SLP
• Jorri Garcia, CSW

• All providers in Logan, UT
• Speech-Language Pathologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.