Individual provider Active NPI

Jacqueline Elizabeth Erhart, MS, CCC-SLP

  • Speech-Language Pathologist
  • Victoria, MN
National Provider Identifier
1780357129
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
518182 Issued in MN
Practice address
1772 Stieger Lake LN
Victoria, MN 55386-7723
Phone
(952) 443-9888
NPI assigned
Jul 30, 2021
Last updated
Jul 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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 518182 MN Primary

Addresses

Primary practice location

1772 Stieger Lake LN
Victoria, MN 55386-7723

Mailing address

2605 Bobolink Rd
Long Lake, MN 55356-9267
Phone (612) 619-0726

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211220001867 MN Practitioner - Qualified Speech Language Pathologist 8325439771 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
518182MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kid Talk Inc Speech-Language Pathologist CurrentSince Sep 18, 2021 Accepting new patients
Kid Talk Inc CurrentSince Sep 18, 2021 Accepting new patients

Locations

8758 Egan Dr
Savage, MN 55378
Phone (952) 226-2999

1772 Stieger Lake Ln
Victoria, MN 55386
Phone (952) 443-9888

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": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1780357129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 BOBOLINK RD",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553569267",
            "telephone_number": "612-619-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 STIEGER LAKE LN",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553867723",
            "telephone_number": "952-443-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERHART",
        "first_name": "JACQUELINE",
        "middle_name": "ELIZABETH",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "518182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.