Individual provider Active NPI

Amanda Schnierle Larsen, CCC-SLP

  • Speech-Language Pathologist
  • Fairfield, CA
National Provider Identifier
1902286479
Registry record updated May 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
21099 Issued in CA
Practice address
707 Kentucky St
Fairfield, CA 94533-5515
Phone
(707) 759-3716
NPI assigned
May 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2015

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 21099 CA Primary

Addresses

Primary practice location

707 Kentucky St
Fairfield, CA 94533-5515

Mailing address

8400 Futurity CT
Antelope, CA 95843-5051
Phone (916) 708-7472

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

State licenses

LicenseStateTypeSpecialty
21099CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Unity Therapies Speech-Language Pathologist Past Accepting new patients
Jewett and Associates Inc Speech-Language Pathologist PastSince Feb 1, 2016 Accepting new patients

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": "1433030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433030400000",
    "number": "1902286479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 FUTURITY CT",
            "city": "ANTELOPE",
            "state": "CA",
            "postal_code": "958435051",
            "telephone_number": "916-708-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 KENTUCKY ST",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945335515",
            "telephone_number": "707-759-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHNIERLE LARSEN",
        "first_name": "AMANDA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-31",
        "last_updated": "2015-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "21099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2015; 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.