Active NPI
Krista Mari De Jesus
- Speech-Language Pathologist
- Clinton Township, MI
National Provider Identifier
1982371522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 43475 Dalcoma Dr Ste 208
Clinton Township, MI 48038-3593 - Phone
- (586) 690-6234
- NPI assigned
- Aug 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
43475 Dalcoma Dr Ste 208
Clinton Township, MI 48038-3593
Mailing address
43475 Dalcoma Dr Ste 208
Clinton Township, MI 48038-3593
Phone (586) 690-6234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241212003064 | MI | Practitioner - Qualified Speech Language Pathologist | 5395271498 | Practice locations: Sterling Heights, MI |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1982371522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43475 DALCOMA DR STE 208",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480383593",
"telephone_number": "586-690-6234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43475 DALCOMA DR STE 208",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480383593",
"telephone_number": "586-690-6234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "KRISTA MARI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-23",
"last_updated": "2024-10-30",
"certification_date": "2024-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.