Jane Licatovich, MSCCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL005351L Issued in PA

Practice address

500 Philadelphia Ave
Shillington, PA 19607-2764

Phone

(610) 796-7022

NPI assigned

Jun 24, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245801600000",
    "number": "1730317181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E 1ST ST FL 3E",
            "city": "BIRDSBORO",
            "state": "PA",
            "postal_code": "195082375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PHILADELPHIA AVE",
            "city": "SHILLINGTON",
            "state": "PA",
            "postal_code": "196072764",
            "telephone_number": "610-796-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATOVICH",
        "first_name": "JANE",
        "credential": "MSCCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2009-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL005351L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Shillington, PA
• Providers in Shillington, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.