Individual provider Active NPI

Rachel Eleanor Jellison, M.S., CF-SLP

  • Speech-Language Pathologist
  • Fargo, ND
National Provider Identifier
1801535323
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2100 Issued in ND
Practice address
4342 15TH Ave S Ste 105
Fargo, ND 58103-1125
Phone
(701) 936-9495
Fax
(952) 222-1994
NPI assigned
Jun 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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 2100 ND Primary

Addresses

Primary practice location

4342 15TH Ave S Ste 105
Fargo, ND 58103-1125

Mailing address

4342 15TH Ave S Ste 105
Fargo, ND 58103-1125
Phone (701) 936-9495

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230331001109 ND Practitioner - Qualified Speech Language Pathologist 9830564079 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2100NDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Embrace Therapy Services Speech-Language Pathologist CurrentSince Dec 9, 2024 Accepting new patients

Locations

4342 15th Ave S
Ste 105
Fargo, ND 58103
Phone (701) 936-9495

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1801535323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4342 15TH AVE S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031125",
            "telephone_number": "701-936-9495",
            "fax_number": "952-222-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4342 15TH AVE S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031125",
            "telephone_number": "701-936-9495",
            "fax_number": "952-222-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELLISON",
        "first_name": "RACHEL",
        "middle_name": "ELEANOR",
        "credential": "M.S., CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-02",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "2100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.