Jennifer Pert Russo, MA CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP765 Issued in ME

Practice address

39 Limerick Rd
Arundel, ME 04046-8158

Phone

(207) 391-0331

Fax

(207) 985-6703

NPI assigned

Jan 29, 2007

Last updated

Sep 8, 2023By 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

• Miss Jennifer Jill Pert Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1760528566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 WOODRIDGE DR",
            "city": "STEEP FALLS",
            "state": "ME",
            "postal_code": "040856860",
            "telephone_number": "207-251-1347",
            "fax_number": "207-985-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 LIMERICK RD",
            "city": "ARUNDEL",
            "state": "ME",
            "postal_code": "040468158",
            "telephone_number": "207-391-0331",
            "fax_number": "207-985-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JENNIFER",
        "middle_name": "PERT",
        "name_prefix": "Mrs.",
        "credential": "MA CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ME",
            "license": "SP765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PERT",
            "middle_name": "JILL",
            "prefix": "MISS",
            "credential": "MA CCC SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Arundel, ME
• Providers in Arundel, ME by specialty
• Speech-Language Pathologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.