409 Therapy Services, PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

409 THERAPY SERVICES, PLLC

Practice address

139 Private Road 5396
Kirbyville, TX 75956-3235

Phone

(409) 449-5498

Fax

(409) 449-6079

NPI assigned

May 18, 2022

Organization subpart

No

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

Authorized official

Name

Jessica Petty, M.S. CCC-SLPNPI 1457784167

Title

Owner / Operator

Phone

(409) 289-1426

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

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

• Jessica Petty

  • Speech-Language Pathologist
  • Port Orange, FL
  • NPI 1457784167
  NPD Authorized official
• Amber Kristine Johnson, SLP-A

  • Speech-Language Assistant
  • Kirbyville, TX
  • NPI 1649976721
  NPD

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1972240166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 PRIVATE ROAD 5396",
            "city": "KIRBYVILLE",
            "state": "TX",
            "postal_code": "759563235",
            "telephone_number": "409-289-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 PRIVATE ROAD 5396",
            "city": "KIRBYVILLE",
            "state": "TX",
            "postal_code": "759563235",
            "telephone_number": "409-449-5498",
            "fax_number": "409-449-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "409 THERAPY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER / OPERATOR",
        "authorized_official_telephone_number": "409-289-1426",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457784167",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Alexander
• Aspire to Be Better Clinic
• Lonnie James Bean Jr., M.D.
• Stewart Elgen Braddock, DDS
• Brookshire Bros Pharmacy of Kirbyville Texas

• Speech-Language Pathologist in Kirbyville, TX
• Providers in Kirbyville, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.