Individual provider Active NPI

Jessica Ahn, M.A., CCC - SLP

  • Speech-Language Pathologist
  • Staten Island, NY
National Provider Identifier
1912288366
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
021309-1 Issued in NY
Practice address
2324 Forest Ave
Staten Island, NY 10303-1506
Phone
(718) 447-0200
Fax
(718) 981-1431
NPI assigned
Aug 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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 021309-1 NY Primary

Addresses

Primary practice location

2324 Forest Ave
Staten Island, NY 10303-1506

Mailing address

23919 66TH Ave
3Rd Floor
Douglaston, NY 11362-1922
Phone (646) 510-1464

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)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
021309NYMDClinical Psychologist
021309-1NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1912288366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23919 66TH AVE",
            "address_2": "3RD FLOOR",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113621922",
            "telephone_number": "646-510-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2324 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031506",
            "telephone_number": "718-447-0200",
            "fax_number": "718-981-1431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHN",
        "first_name": "JESSICA",
        "credential": "M.A., CCC - SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "021309-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; 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.