Individual provider Active NPI

Chelsea Russo, CCC-SLP

  • Speech-Language Pathologist
  • Kinnelon, NJ
National Provider Identifier
1760265672
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
41YS01178200 Issued in NJ
Practice address
187 Kakeout Rd
Kinnelon, NJ 07405-2538
Phone
(973) 270-4487
NPI assigned
Aug 15, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS01178200 NJ Primary

Addresses

Primary practice location

187 Kakeout Rd
Kinnelon, NJ 07405-2538

Mailing address

187 Kakeout Rd
Kinnelon, NJ 07405-2538
Phone (973) 270-4487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231025000966 NJ Practitioner - Qualified Speech Language Pathologist 5193171338 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

175 Quaker Church Rd
Randolph, NJ 07869-1415
Phone (973) 293-5031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Jul 9, 2024 Accepting new patients
Life Home Therapy LLC Speech-Language Pathologist CurrentSince Jul 20, 2023 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Jul 9, 2024 Accepting new patients
Prestige Rehab LLC Speech-Language Pathologist CurrentSince Dec 13, 2023 Accepting new patients

Locations

70 S Orange Ave
Ste 220
Livingston, NJ 07039
Phone (973) 626-2350

175 Quaker Church Rd
Randolph, NJ 07869
Phone (973) 293-5031

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1760265672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 KAKEOUT RD",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052538",
            "telephone_number": "973-270-4487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 KAKEOUT RD",
            "city": "KINNELON",
            "state": "NJ",
            "postal_code": "074052538",
            "telephone_number": "973-270-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "CHELSEA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS01178200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kinnelon, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.