Individual provider Active NPI

Jenna Mulry

  • Speech-Language Pathologist
  • Sandusky, OH
National Provider Identifier
1861802209
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP.10911 Issued in OH
Practice address
2020 Jeanette Dr
Sandusky, OH 44870-7100
Phone
(419) 366-3419
NPI assigned
May 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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 SP.10911 OH Primary

Addresses

Primary practice location

2020 Jeanette Dr
Sandusky, OH 44870-7100

Mailing address

2020 Jeanette Dr
Sandusky, OH 44870-7100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241213003341 OH Practitioner - Qualified Speech Language Pathologist 1759817752 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SP.10911OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Engage Wellness LLC Speech-Language Pathologist CurrentSince Nov 1, 2024 Accepting new patients
Engage Wellness LLC Speech-Language Pathologist CurrentSince Nov 1, 2024 Accepting new patients

Locations

6591 W Central Ave
Ste 105
Toledo, OH 43617
Phone (419) 345-7645

Organizations & group practices 2

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": "1399420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1861802209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 JEANETTE DR",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448707100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 JEANETTE DR",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448707100",
            "telephone_number": "419-366-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULRY",
        "first_name": "JENNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-07",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP.10911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; 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.