Jennifer Nicklas, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2009005833 Issued in MO

Practice address

1115 Fairgrounds Rd
Jefferson City, MO 65109-5443

Phone

(573) 634-3070

Fax

(573) 636-3247

NPI assigned

Apr 11, 2007

Last updated

Apr 7, 2009By 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Capital City Area Council for Special Services

  dba The Special Learning Center

  • Local Education Agency (LEA)
  • Jefferson City, MO
  • NPI 1629417035
  NPD (past)
• Capital City Area Council for Special Services

  dba Special Learning Center

  • Speech-Language Pathologist
  • Jefferson City, MO
  • NPI 1982749495
  NPD (past)

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239062400000",
    "number": "1770706038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5409 BULL ROCK RD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096277",
            "telephone_number": "573-634-3070",
            "fax_number": "573-636-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 FAIRGROUNDS RD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095443",
            "telephone_number": "573-634-3070",
            "fax_number": "573-636-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAS",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2009-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2009005833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "461466500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Patrick Newman II, MD
• Oanh Ngo, FNP-C
• Nicholas Oneal Transport
• Brandi Nichols, MD
• Pagena M Nichols, LPC
• Jessica Marie Nicolaescu, MOT,OTR/L
• Aimee Lou Nienstedt Dickson, LCSW, LCSW, PMH-C
• Thomas B Nittler, MD
• Jill Nitz
• Mark Nitz

• Speech-Language Pathologist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.