Jenessa Lynn Baxter, SLP-3375

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-3375 Issued in ID

Practice address

14526 W Comisky Dr
Boise, ID 83713-0966

Phone

(208) 880-1554

NPI assigned

Dec 14, 2016

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

• Jenessa Lynn Burroughs, Harrison Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1770027484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14526 W COMISKY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130966",
            "telephone_number": "208-880-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14526 W COMISKY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130966",
            "telephone_number": "208-880-1554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 N 3rd E",
            "address_purpose": "LOCATION",
            "city": "Mountain Home",
            "state": "ID",
            "postal_code": "83647",
            "country_code": "US",
            "telephone_number": "208-587-8255",
            "fax_number": "208-587-4475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAXTER",
        "first_name": "JENESSA",
        "middle_name": "LYNN",
        "credential": "SLP-3375",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-14",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-3375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENESSA",
            "last_name": "BURROUGHS, HARRISON",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brandon Robert Bautista
• Carlos Bautista, MD
• Lesena Bautista
• Daniel Bawcom, RN
• Jamie Lou Baxter
• Norma Sue Spring Baxter, LCSW
• Raquel Baxter, D.D.S
• Susan Elizabeth Baxter, MD
• Christy Bayes, NP
• Mikaela Bayless

• All providers in Boise, ID
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.