Active NPI
Jackie Havens
- Speech-Language Pathologist
- El Centro, CA
National Provider Identifier
1770396145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 33848
- Practice address
- 1402 W Pico Ave Ste A30
El Centro, CA 92243-1377 - Phone
- (760) 259-5316
- NPI assigned
- Jan 29, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 | 33848 | CA | Primary |
Addresses
Primary practice location
1402 W Pico Ave Ste A30
El Centro, CA 92243-1377
Mailing address
1499 N 12TH St
El Centro, CA 92243-1375
Phone (760) 259-5316
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 |
|---|---|---|---|
| 33848 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738108800000",
"number": "1770396145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1499 N 12TH ST",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922431375",
"telephone_number": "760-259-5316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 W PICO AVE STE A30",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922431377",
"telephone_number": "760-259-5316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVENS",
"first_name": "JACKIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-29",
"last_updated": "2025-01-29",
"certification_date": "2025-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "33848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Centro, CA
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- Hanger Prosthetics & Orthotics West, Inc.
- Melissa Haro
- Faith Daisy Harrison, PHARMD
- Sandra Ellen Cordelia Hatman, NNP-BC
- Hazem Zekry MD
- HD Elshire III MD PHD Facs, Inc
- Healthpeak Home Health, Inc.
- Heart of the Valley Cardiology, AMC
- Helping Children Achieve Family Therapy, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.