Individual provider Active NPI

Jessica Marian Romero, M.ED. CCC-SLP

  • Speech-Language Pathologist
  • Dayton, TN
National Provider Identifier
1780010777
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
4936 Issued in TN
Practice address
305 California Ave
Dayton, TN 37321-1409
Phone
(423) 622-1551
NPI assigned
Sep 23, 2013
Last updated
Nov 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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 4936 TN Primary

Addresses

Primary practice location

305 California Ave
Dayton, TN 37321-1409

Mailing address

9040 Executive Park Dr
Suite 105
Knoxville, TN 37923-4640
Phone (912) 614-1336

Other identifiers 1

IdentifierTypeStateIssuer
Q001678MedicaidTN

Other names 1

  • Jessica Marian Yarbrough Former name

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
4936TNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Stellar Medical Services, LLC PastSince May 25, 2021 Accepting new patients
Stellartherapy Services, LLC Speech-Language Pathologist PastSince Nov 24, 2019 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1780010777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 EXECUTIVE PARK DR",
            "address_2": "SUITE 105",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234640",
            "telephone_number": "912-614-1336",
            "fax_number": "865-769-0801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 CALIFORNIA AVE",
            "city": "DAYTON",
            "state": "TN",
            "postal_code": "373211409",
            "telephone_number": "423-622-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMERO",
        "first_name": "JESSICA",
        "middle_name": "MARIAN",
        "credential": "M.ED. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "4936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q001678",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "YARBROUGH",
            "middle_name": "MARIAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dayton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; 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.