Kaide Lynn Jackstadt

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

KAIDE LYNN JACKSTADT

Practice address

189 E US Highway 40 Ste D
Troy, IL 62294-2267

Phone

(618) 420-3999

NPI assigned

Nov 21, 2018

Organization subpart

No

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

Authorized official

Name

Kaide Jackstadt

Title

SLP/Owner

Phone

(618) 420-3999

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542758400000",
    "number": "1801365754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 E US HIGHWAY 40 STE D",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622942267",
            "telephone_number": "618-420-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 E US HIGHWAY 40 STE D",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622942267",
            "telephone_number": "618-420-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIDE LYNN JACKSTADT",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-21",
        "last_updated": "2018-11-21",
        "status": "A",
        "authorized_official_last_name": "JACKSTADT",
        "authorized_official_first_name": "KAIDE",
        "authorized_official_title_or_position": "SLP/OWNER",
        "authorized_official_telephone_number": "618-420-3999"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Troy, IL
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• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.