Ann S Wallace, MS SPEECH PATHOLOGY

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

13774 Issued in TX

Practice address

2620 Russell Long Blvd
Vhac 242, Dept. of Comm. Dis.
Canyon, TX 79016-0001

Phone

(806) 651-5114

Fax

(806) 651-5105

NPI assigned

Sep 18, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ann Samuel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1013240340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60757",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790160001",
            "telephone_number": "806-651-5114",
            "fax_number": "806-651-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 RUSSELL LONG BLVD",
            "address_2": "VHAC 242, DEPT. OF COMM. DIS.",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790160001",
            "telephone_number": "806-651-5114",
            "fax_number": "806-651-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANN",
        "middle_name": "S",
        "credential": "MS SPEECH PATHOLOGY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-18",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "13774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "SAMUEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Canyon, TX
• Providers in Canyon, 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 20, 2012; 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.