Jessica Ann Marie Kollaros, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

C-5124 Issued in NM

Practice address

11350 Random Hills Rd Ste 885
Fairfax, VA 22030-6044

Phone

(703) 342-4690

NPI assigned

Jun 29, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1780948257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14706 RICHARD SIMPSON LN",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201216214",
            "telephone_number": "575-496-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 RANDOM HILLS RD STE 885",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306044",
            "telephone_number": "703-342-4690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Hillrise Cir",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880114759",
            "country_code": "US",
            "telephone_number": "575-522-9528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLLAROS",
        "first_name": "JESSICA",
        "middle_name": "ANN MARIE",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202007156",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "DC",
            "license": "SLP001501",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "C-5124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy E. Koeppen, LCSW
• Regina Anne Koffman
• Koh & Associates, DDS, P.C.
• Rachel Kokal, PA-C
• Laurel Kokilananda, MS, BCBA
• Jeanine Kolman, PT
• Mohammad R Komaily, D.C.
• Crystal Kominar
• Aisha Amadou Konare
• Jennifer Olek Konchar, MSPT

• Speech-Language Pathologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.