Jaclyn Gannon

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

6622 Avalon Forest Dr
Indianapolis, IN 46250-2804

Phone

(567) 239-2514

NPI assigned

Oct 14, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Kinsman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Language at Play Speech Therapy LLC

  • Speech-Language Pathologist
  • Indianapolis, IN
  • NPI 1104550193
  NPD (past)

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1841010840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12505 BENTLEY BLVD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460381223",
            "telephone_number": "567-239-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6622 AVALON FOREST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502804",
            "telephone_number": "567-239-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "KINSMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Priya Gangwani, PT
• Charlotte I Gangwer, RN, NP
• Stephanie Rose Ganley, PT
• Connor Ganly, PHARMD
• Christine Pasierbowicz Gann, LCSW
• Steven Gannon, M.D.
• Suzanne M Gano
• Gant Family Home Care LLC
• Gant Family Home Health Care LLC
• Amanda Lindsay Gant

• Speech-Language Pathologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.