Individual provider Active NPI

Jessica Tracy

  • Speech-Language Pathologist
  • Chandler, AZ
National Provider Identifier
1912578501
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
TSLP13148 Issued in AZ
Practice address
3160 N Arizona Ave Ste 105
Chandler, AZ 85225-7122
Phone
(480) 365-9981
NPI assigned
Jul 6, 2021
Last updated
Jul 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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 TSLP13148 AZ Primary

Addresses

Primary practice location

3160 N Arizona Ave Ste 105
Chandler, AZ 85225-7122

Mailing address

223 Woodycrest Dr
Holtsville, NY 11742-1714
Phone (631) 560-8597

Other practice location 1

10211 E Madero Ave
Mesa, AZ 85209-1493
Phone (480) 635-2025

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
TSLP13148AZMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1912578501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 WOODYCREST DR",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "117421714",
            "telephone_number": "631-560-8597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3160 N ARIZONA AVE STE 105",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852257122",
            "telephone_number": "480-365-9981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10211 E Madero Ave",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852091493",
            "country_code": "US",
            "telephone_number": "480-635-2025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRACY",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "TSLP13148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.