Individual provider Active NPI

Jacqueline Cullen, SLP

  • Speech-Language Pathologist
  • Woburn, MA
National Provider Identifier
1801092838
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
016157 Issued in NY
Practice address
400 W Cummings Park
Woburn, MA 01801-6519
Phone
(781) 933-8800
NPI assigned
Jun 26, 2007
Last updated
Jun 27, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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 016157 NY Primary

Addresses

Primary practice location

400 W Cummings Park
Woburn, MA 01801-6519

Mailing address

927 Manor LN
Bay Shore, NY 11706-7526
Phone (631) 661-5995

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240119003346 NY Practitioner - Qualified Speech Language Pathologist 7719339290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optimum Therapeutics PT and OT PLLCGroup PAC ID 5991977712, 41 clinicians

Practice addresses (Care Compare)

1 Huntington Quadrangle
Suite 1S07
Melville, NY 11747-4426
Phone (516) 222-2010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016157NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optimum Therapeutics PT & OT PLLC CurrentSince Dec 10, 2023 Accepting new patients
Rehabpro Physical Therapy, PC PastSince Jun 12, 2019 Accepting new patients
Propel Physical Therapy PC PastSince Dec 10, 2023 Accepting new patients

Locations

1 Huntington Quadrangle
Ste 1S07
Melville, NY 11747
Phone (516) 222-2010

560 Broadhollow Rd
Ste 304
Melville, NY 11747
Phone (516) 222-2010

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, 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": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214524800000",
    "number": "1801092838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 MANOR LN",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067526",
            "telephone_number": "631-661-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W CUMMINGS PARK",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018016519",
            "telephone_number": "781-933-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "JACQUELINE",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2008-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "016157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.