Active NPI
Jake Crosley, CCC-SLP
- Speech-Language Pathologist
- Warsaw, IN
National Provider Identifier
1760021497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22006957A
- Practice address
- 900 Provident Dr
Warsaw, IN 46580-3252 - Phone
- (574) 371-2500
- NPI assigned
- Dec 28, 2019
- Sex
- Male
- Sole proprietor
- No
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 | 22006957A | IN | Primary |
Addresses
Primary practice location
900 Provident Dr
Warsaw, IN 46580-3252
Mailing address
114 W Cambridge Dr
Columbia City, IN 46725-7785
Phone (260) 241-8305
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22006957A | IN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577491200000",
"number": "1760021497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 W CAMBRIDGE DR",
"city": "COLUMBIA CITY",
"state": "IN",
"postal_code": "467257785",
"telephone_number": "260-241-8305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 PROVIDENT DR",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803252",
"telephone_number": "574-371-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSLEY",
"first_name": "JAKE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-28",
"last_updated": "2019-12-28",
"certification_date": "2019-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22006957A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warsaw, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.