Active NPI
Devan Meade Decicco, M.A., CCC-SLP
- Speech-Language Pathologist
- Watertown, NY
National Provider Identifier
1669732046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 021925-1
- Practice address
- 1351 Washington St
Watertown, NY 13601-4531 - Phone
- (315) 785-3700
- NPI assigned
- May 21, 2012
- Last updated
- Jul 17, 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 | 021925-1 | NY | Primary |
Addresses
Primary practice location
1351 Washington St
Watertown, NY 13601-4531
Mailing address
434 Bugbee Dr
Watertown, NY 13601-4204
Phone (315) 956-9773
Other practice location 1
159 W 1st St
Oswego, NY 13126-2045
Phone (315) 342-9575
Other practice location 2
16783 Ives Street Ext
Watertown, NY 13601-5312
Phone (315) 788-5377
Other practice location 3
830 Washington St
Watertown, NY 13601-4034
Phone (315) 784-4000
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021925-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563321600000",
"number": "1669732046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 BUGBEE DR",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136014204",
"telephone_number": "315-956-9773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1351 WASHINGTON ST",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136014531",
"telephone_number": "315-785-3700"
}
],
"practiceLocations": [
{
"address_1": "159 W 1st St",
"address_purpose": "LOCATION",
"city": "Oswego",
"state": "NY",
"postal_code": "131262045",
"country_code": "US",
"telephone_number": "315-342-9575",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16783 Ives Street Ext",
"address_purpose": "LOCATION",
"city": "Watertown",
"state": "NY",
"postal_code": "136015312",
"country_code": "US",
"telephone_number": "315-788-5377",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "830 Washington St",
"address_purpose": "LOCATION",
"city": "Watertown",
"state": "NY",
"postal_code": "136014034",
"country_code": "US",
"telephone_number": "315-784-4000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DECICCO",
"first_name": "DEVAN",
"middle_name": "MEADE",
"name_prefix": "Mr.",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-05-21",
"last_updated": "2019-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "021925-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.