Jackie St Marie, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

1014 Burrell Ave
Lewiston, ID 83501-5472

Phone

(208) 743-4558

NPI assigned

Dec 16, 2021

Last updated

Dec 16, 2021By the provider in NPPES

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 names 1

• Jackie Decianne Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1699434639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE STE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697",
            "telephone_number": "971-364-0611",
            "fax_number": "971-364-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 BURRELL AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835015472",
            "telephone_number": "208-743-4558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST MARIE",
        "first_name": "JACKIE",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "DECIANNE",
            "credential": "SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• St. Joseph Hospital, LLC
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• St. Joseph Hospital, LLC (St. Joseph Regional Medical Center)
• St. Joseph Regional Medical Center (St. Joseph Medical Group)

• Speech-Language Pathologist in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.