NPIMap

Individual provider Active NPI

Jessica Kaczmarek

  • Speech-Language Pathologist
  • Glendale, AZ
National Provider Identifier
1780177121
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
19000 N 63Rd Ave
Glendale, AZ 85308-7138
Phone
(623) 376-4300
NPI assigned
Jun 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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 Primary

Addresses

Primary practice location

19000 N 63Rd Ave
Glendale, AZ 85308-7138

Mailing address

17100 E Shea Blvd Ste 600
Fountain Hills, AZ 85268-6663
Phone (480) 837-4565

Other names 1

  • Jessica Cannata 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

Practice roles

OrganizationSpecialtyStatusNew patients
Piller Child Development Past Accepting new patients
Piller Child Development LLC Speech-Language Pathologist PastSince Nov 1, 2017 Accepting new patients
Cholla Medical Group, Inc PastSince Dec 15, 2006 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1780177121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17100 E SHEA BLVD STE 600",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852686663",
            "telephone_number": "480-837-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19000 N 63RD AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087138",
            "telephone_number": "623-376-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZMAREK",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-11",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CANNATA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.