Active NPI
Jennifer L Raulerson, SLP
- Speech-Language Pathologist
- Waycross, GA
National Provider Identifier
1801063177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP005585
- Practice address
- 2019 Alice St
Suite B
Waycross, GA 31501-6209 - Phone
- (706) 614-2248
- Fax
- (706) 353-1606
- NPI assigned
- May 14, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP005585 | GA | Primary |
Addresses
Primary practice location
2019 Alice St
Suite B
Waycross, GA 31501-6209
Mailing address
PO Box 673
Patterson, GA 31557-0673
Phone (706) 614-2248
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52058554002 | Other | GA | BCBS OF GA |
| 833369342A | Medicaid | GA | |
| 344381 | Other | GA | WELLCARE HEALTH - GA REGION |
| 10080845 | Other | GA | AMERIGROUP COMMUNITY CARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP005585 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1801063177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 673",
"city": "PATTERSON",
"state": "GA",
"postal_code": "315570673",
"telephone_number": "706-614-2248",
"fax_number": "706-353-1606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2019 ALICE ST",
"address_2": "SUITE B",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315016209",
"telephone_number": "706-614-2248",
"fax_number": "706-353-1606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAULERSON",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-14",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP005585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF GA",
"identifier": "52058554002",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "833369342A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE HEALTH - GA REGION",
"identifier": "344381",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP COMMUNITY CARE",
"identifier": "10080845",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waycross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.