KELSEY JACOBSEN CCC-SLP
NPI 1235596099
Speech-Language Pathologist in Los Gatos, CA
About Kelsey Jacobsen Ccc-slp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELSEY JACOBSEN CCC-SLP (NPI 1235596099) is an individual speech-language pathologist provider in Los Gatos, California, licensed in California (22665) and active in the NPI registry since January 2016.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelsey Jacobsen Ccc-slp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelsey Jacobsen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Santa Clara, CA 95051
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelsey Jacobsen's NPI number?
The NPI number for Kelsey Jacobsen is 1235596099. It was assigned to this individual provider in the NPPES registry on January 25, 2016.
Where is Kelsey Jacobsen located?
Kelsey Jacobsen practices at 17196 Fawndale Dr, Los Gatos, CA 95032. The listed phone number is (408) 219-9947.
What is Kelsey Jacobsen's specialty?
The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.
Is Kelsey Jacobsen enrolled in Medicare?
Yes. Kelsey Jacobsen is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelsey Jacobsen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelsey Jacobsen reassigns Medicare benefits to Permanente Medical Group Inc (Santa Clara, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelsey Jacobsen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelsey Jacobsen was last updated on February 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelsey Jacobsen, CCC-SLP · NPI 1235596099
Speech-Language Pathologist provider in Los Gatos, California. Individual provider, active in the CMS NPPES registry since January 25, 2016.
## Identity
- **NPI:** 1235596099 (Entity type: Individual)
- **Enumerated:** January 25, 2016
- **Primary specialty:** Speech-Language Pathologist · taxonomy 235Z00000X
- **State license:** 22665 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 17196 FAWNDALE DR, Los Gatos, CA 95032-6501
- **Phone:** (408) 219-9947
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Permanente Medical Group Inc (NPI 1073606299, Santa Clara, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 11, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1235596099) · Data from the CMS NPPES public registry.