Individual provider Active NPI

Judith L Intagliata, SLP

  • Speech-Language Pathologist
  • Portage, IN
National Provider Identifier
1992902118
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
22004089A Issued in IN
Practice address
6040 Lute Rd
Portage, IN 46368-5008
Phone
(219) 763-6858
Fax
(219) 763-4858
NPI assigned
Jun 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 22004089A IN Primary

Addresses

Primary practice location

6040 Lute Rd
Portage, IN 46368-5008

Mailing address

52 Harrison Blvd
Valparaiso, IN 46383-3408
Phone (219) 548-3242

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
22004089AINMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992902118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 HARRISON BLVD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463833408",
            "telephone_number": "219-548-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 LUTE RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685008",
            "telephone_number": "219-763-6858",
            "fax_number": "219-763-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INTAGLIATA",
        "first_name": "JUDITH",
        "middle_name": "L",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22004089A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.