NPIMap

Organization Active NPI

Jeter Speech Language Pathology Services, LLC

Doing business as Jeter Therapy Group

  • Speech-Language Pathologist
  • Shreveport, LA
National Provider Identifier
1851924237
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
JETER SPEECH LANGUAGE PATHOLOGY SERVICES, LLC
Doing business as
Jeter Therapy Group
Practice address
1950 E 70TH St Ste a
Shreveport, LA 71105-5345
Phone
(318) 219-6064
Fax
(318) 225-7928
NPI assigned
Feb 13, 2020
Last updated
Feb 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Dana Rene Williams, MCD/CCC-SLPNPI 1508295379
Title
Owner
Phone
(337) 718-3404

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

1950 E 70TH St Ste a
Shreveport, LA 71105-5345

Mailing address

1950 E 70TH St Ste a
Shreveport, LA 71105-5345
Phone (318) 219-6064

Other practice location 1

966 US 80
Haughton, LA 71105
Phone (318) 219-6064

Other identifiers 2

IdentifierTypeStateIssuer
6710OtherLALICENSE
6710OtherLALA LICENSE

Other names 1

  • Jeter Therapy Group Doing business as

Electronic endpoints 3

TypeEndpointUseAffiliation
CONNECT URL Shreveport Health Information Exchange (HIE)
CONNECT URL dana@jeterslpservices.com Direct
Other URL office

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200311000102 LA Part B Supplier - Clinic/Group Practice 3577991348 Receives reassigned benefits from 4 practitioners
Practice locations: Natchitoches, LA; Shreveport, LA

National Provider Directory

National Provider Directory

Locations

126 Highway 504
Natchitoches, LA 71457
Phone (318) 219-6064

1950 E 70th St
Ste A
Shreveport, LA 71105
Phone (318) 219-6064

1950 E 70th St
Ste C
Shreveport, LA 71105
Phone (318) 219-6064

2025 Southern Ave
Shreveport, LA 71104
Phone (318) 219-6064

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1851924237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 E 70TH ST STE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055345",
            "telephone_number": "318-219-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E 70TH ST STE A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055345",
            "telephone_number": "318-219-6064",
            "fax_number": "318-225-7928"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "966 US 80",
            "address_purpose": "LOCATION",
            "city": "Haughton",
            "state": "LA",
            "postal_code": "71105",
            "country_code": "US",
            "telephone_number": "318-219-6064",
            "fax_number": "318-225-7928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JETER SPEECH LANGUAGE PATHOLOGY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-13",
        "last_updated": "2022-02-08",
        "certification_date": "2022-01-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-718-3404",
        "authorized_official_credential": "MCD/CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6710",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA LICENSE",
            "identifier": "6710",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Shreveport",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Shreveport",
            "address_1": "1950 E 70th St Ste C",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711055345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "dana@jeterslpservices.com",
            "affiliation": "N",
            "endpointDescription": "office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1950 E 70th St Ste A",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711055345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "office",
            "affiliation": "N",
            "address_1": "1950 E 70th St Ste A",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711055345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jeter Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.