Jessica R Mabry, CCC-SLP CBIS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA10662 Issued in FL

Practice address

4202 E Fowler Ave
Tampa, FL 33620

Phone

(813) 974-2011

NPI assigned

Apr 1, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• East Pasco Speech Services

  • Speech-Language Pathologist
  • Dade City, FL
  • NPI 1144896507
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533772800000",
    "number": "1689170581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33620",
            "telephone_number": "813-974-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABRY",
        "first_name": "JESSICA",
        "middle_name": "R",
        "credential": "CCC-SLP CBIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-01",
        "last_updated": "2018-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024865200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "7N67F",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Nicole Maass, PA-C
• Mabel Z Echeandia
• Toni Mabien
• Megan Elizabeth Mabis, M.D.
• Mabrook Therapy Services LLC
• Mac Unlimited LLC
• Ryan Wilson Macalua, ARNP, FNP-C
• Alyssa M Macaluso
• Andrew Macaluso
• Anne Elizabeth Macarthur

• Speech-Language Pathologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.