Active NPI
Jamie Lynn Brackemyer, M.S., CCC-SLP
- Speech-Language Pathologist
- Rockford, IL
National Provider Identifier
1891027090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.010492
- Practice address
- 2400 N Rockton Ave
Rockford, IL 61103-3655 - Phone
- (815) 971-5022
- NPI assigned
- Feb 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Speech-Language Pathologist | 235Z00000X | 146.010492 | IL | Primary |
Addresses
Primary practice location
2400 N Rockton Ave
Rockford, IL 61103-3655
Mailing address
47W795 Winterset Rd
Hampshire, IL 60140-8434
Phone (815) 441-3310
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 |
|---|---|---|---|
| 146.010492 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712275200000",
"number": "1891027090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47W795 WINTERSET RD",
"city": "HAMPSHIRE",
"state": "IL",
"postal_code": "601408434",
"telephone_number": "815-441-3310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 N ROCKTON AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611033655",
"telephone_number": "815-971-5022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKEMYER",
"first_name": "JAMIE",
"middle_name": "LYNN",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-12",
"last_updated": "2024-04-05",
"certification_date": "2024-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.010492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.