Amy Jensen-Wisetsarakool, M.S.,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

103194 Issued in TX

Practice address

5242 Medical Dr
Rockwall, TX 75032

Phone

(972) 772-8700

NPI assigned

Nov 2, 2018

Last updated

Nov 2, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541116800000",
    "number": "1871060392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 INDIAN PAINTBRUSH",
            "city": "FATE",
            "state": "TX",
            "postal_code": "750879301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5242 MEDICAL DR",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "75032",
            "telephone_number": "972-772-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "523 Indian Paintbrush Dr",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "75087",
            "country_code": "US",
            "telephone_number": "972-249-5914",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "523 Indian Paintbrush Dr",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "75087",
            "country_code": "US",
            "telephone_number": "972-249-5914",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "523 Indian Paintbrush Dr",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "75087",
            "country_code": "US",
            "telephone_number": "972-249-5914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENSEN-WISETSARAKOOL",
        "first_name": "AMY",
        "credential": "M.S.,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-02",
        "last_updated": "2018-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "103194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Rockwall, TX
• Providers in Rockwall, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2018; 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.