Active NPI
Jacob Ryan Deslongchamps, MS, CCC-SLP
- Speech-Language Pathologist
- Denver, CO
National Provider Identifier
1821864075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP.0005701
- Practice address
- 1143 Ivy St
Denver, CO 80220-4542 - Phone
- (720) 318-4615
- NPI assigned
- Nov 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | SLP.0005701 | CO | Primary |
Addresses
Primary practice location
1143 Ivy St
Denver, CO 80220-4542
Mailing address
1143 Ivy St
Denver, CO 80220-4542
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP.0005701 | CO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proactive Pediatrics, LLC | Single Specialty | Past | Accepting new patients |
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": "1701216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701216000000",
"number": "1821864075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1143 IVY ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802204542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1143 IVY ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802204542",
"telephone_number": "720-318-4615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESLONGCHAMPS",
"first_name": "JACOB",
"middle_name": "RYAN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-29",
"last_updated": "2023-11-29",
"certification_date": "2023-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "CO",
"license": "SLP.0005701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.