NPIMap

Organization Active NPI

Jaci Dale Speech Pathology Services, LLC

  • Speech-Language Pathologist
  • Harrisburg, IL
National Provider Identifier
1912379355
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146.005513 Issued in IL
Legal business name
JACI DALE SPEECH PATHOLOGY SERVICES, LLC
Doing business as
Jaci Dale DBA Jaci Dale
Practice address
701 S Ledford St
Harrisburg, IL 62946-2532
Phone
(618) 253-7019
Fax
(618) 253-7019
NPI assigned
Oct 26, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jaci Rae Dale, M.S., CCC-SLPNPI 1275662728
Title
Owner
Phone
(618) 253-7019

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 146.005513 IL Primary

Addresses

Primary practice location

701 S Ledford St
Harrisburg, IL 62946-2532

Mailing address

701 S Ledford St
Harrisburg, IL 62946-2532
Phone (618) 253-7019

Other identifiers 1

IdentifierTypeStateIssuer
1275662728OtherILNPI

Other names 1

  • Jaci Dale DBA Jaci Dale Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1912379355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S LEDFORD ST",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462532",
            "telephone_number": "618-253-7019",
            "fax_number": "618-253-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S LEDFORD ST",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462532",
            "telephone_number": "618-253-7019",
            "fax_number": "618-253-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACI DALE SPEECH PATHOLOGY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "DALE",
        "authorized_official_first_name": "JACI",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-253-7019",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.005513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275662728",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jaci Dale DBA Jaci Dale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrisburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.