Jackie Wachob, M.S. SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

007669 Issued in NY

Practice address

431 Thornell Rd
Pittsford, NY 14534-9750

Phone

(585) 267-1732

NPI assigned

Jan 5, 2015

Last updated

Jan 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pittsford Central School District

  • Local Education Agency (LEA)
  • Pittsford, NY
  • NPI 1053449629
  NPD (past)

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420416000000",
    "number": "1962890558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BARKER RD",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145342929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 THORNELL RD",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145349750",
            "telephone_number": "585-267-1732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHOB",
        "first_name": "JACKIE",
        "name_prefix": "Mrs.",
        "credential": "M.S. SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "007669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vital Health Medical Care, PLLC
• Vital Health Medical Care, PLLC
• Vitality in Aging Psychiatry, PLLC
• Maria Louella Lopez Vivino, M.D.
• Jennifer E Vogt, PT
• Rachel Wager, DPT
• Carla Jean Waleski
• Walgreen Co (Walgreens #19495)
• Jayna Lynn Walker, LPN
• Bianca Elizabeth Barber Wallace

• Speech-Language Pathologist in Pittsford, NY
• Providers in Pittsford, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.